Provider Demographics
NPI: | 1932427143 |
---|---|
Name: | FRONTIER HEALTH CLINIC, PC |
Entity Type: | Organization |
Organization Name: | FRONTIER HEALTH CLINIC, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LAURELI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCRIBNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | FNP |
Authorized Official - Phone: | 406-323-4002 |
Mailing Address - Street 1: | PO BOX 646 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROUNDUP |
Mailing Address - State: | MT |
Mailing Address - Zip Code: | 59072-0646 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 406-323-4002 |
Mailing Address - Fax: | 406-323-4022 |
Practice Address - Street 1: | 25 1ST AVE W |
Practice Address - Street 2: | |
Practice Address - City: | ROUNDUP |
Practice Address - State: | MT |
Practice Address - Zip Code: | 59072-2831 |
Practice Address - Country: | US |
Practice Address - Phone: | 406-323-4002 |
Practice Address - Fax: | 406-323-4022 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-05-12 |
Last Update Date: | 2010-05-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MT | 24302 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |