Provider Demographics
NPI:1750199006
Name:FRONTIER DIRECT CARE - DALLAS
Entity type:Organization
Organization Name:FRONTIER DIRECT CARE - DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-212-4207
Mailing Address - Street 1:119 W VAN BUREN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-6414
Mailing Address - Country:US
Mailing Address - Phone:945-212-2370
Mailing Address - Fax:945-202-3743
Practice Address - Street 1:8240 MOBERLY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2043
Practice Address - Country:US
Practice Address - Phone:945-212-2370
Practice Address - Fax:945-202-3743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONTIER DIRECT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty