1144460817 NPI number — FRONTIER HEALTH

Table of content: (NPI 1144460817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144460817 NPI number — FRONTIER HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONTIER HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ELDRETH HOUSE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144460817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1167 SPRATLIN PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-6205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-247-4000
Provider Business Mailing Address Fax Number:
423-467-3644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-247-4000
Provider Business Practice Location Address Fax Number:
423-467-3644
Provider Enumeration Date:
02/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMMONDS
Authorized Official First Name:
KRISTIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
423-467-3600

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  L000000002478 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)