Provider Demographics
NPI:1861734741
Name:FRONTERA HEALTHCARE NETWORK INC
Entity type:Organization
Organization Name:FRONTERA HEALTHCARE NETWORK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAM
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:KLEIBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-869-5500
Mailing Address - Street 1:140 INDUSTRIAL LOOP
Mailing Address - Street 2:STE 2
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5456
Mailing Address - Country:US
Mailing Address - Phone:830-992-2593
Mailing Address - Fax:
Practice Address - Street 1:140 INDUSTRIAL LOOP
Practice Address - Street 2:STE 2
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5456
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:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)