Provider Demographics
NPI:1992396949
Name:FRONTERA HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:FRONTERA HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-869-5500
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0989
Mailing Address - Country:US
Mailing Address - Phone:325-869-5500
Mailing Address - Fax:325-869-5692
Practice Address - Street 1:1426 E MAIN ST STE 300-400
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5308
Practice Address - Country:US
Practice Address - Phone:325-869-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)