Provider Demographics
NPI:1982625828
Name:FROST FAMILY MEDICINE
Entity Type:Organization
Organization Name:FROST FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:843-815-5211
Mailing Address - Street 1:PO BOX 1577
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-1577
Mailing Address - Country:US
Mailing Address - Phone:843-815-5211
Mailing Address - Fax:843-815-5213
Practice Address - Street 1:29 PLANTATION PARK DR
Practice Address - Street 2:SUITE 602
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9001
Practice Address - Country:US
Practice Address - Phone:843-815-5211
Practice Address - Fax:843-815-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27106261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4009Medicaid
SC8072Medicare PIN