Provider Demographics
NPI:1740787852
Name:FRONTIER HEALTH CLINIC PC
Entity Type:Organization
Organization Name:FRONTIER HEALTH CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:BELINDA
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:323-820-7181
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:HERLONG
Mailing Address - State:CA
Mailing Address - Zip Code:96113-0939
Mailing Address - Country:US
Mailing Address - Phone:530-331-0324
Mailing Address - Fax:
Practice Address - Street 1:742-450 HERLONG ACCESS ROAD
Practice Address - Street 2:
Practice Address - City:HERLONG
Practice Address - State:CA
Practice Address - Zip Code:96113
Practice Address - Country:US
Practice Address - Phone:530-331-0324
Practice Address - Fax:530-331-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center