Provider Demographics
NPI:1902686116
Name:FRONTLINE MOBILE HEALTH
Entity Type:Organization
Organization Name:FRONTLINE MOBILE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APA-C
Authorized Official - Phone:512-838-3808
Mailing Address - Street 1:6517 N LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-9530
Mailing Address - Country:US
Mailing Address - Phone:512-838-3808
Mailing Address - Fax:
Practice Address - Street 1:6517 N LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-9530
Practice Address - Country:US
Practice Address - Phone:512-838-3808
Practice Address - Fax:512-253-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty