1194703710 NPI number — FRONTIER GROUP, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194703710 NPI number — FRONTIER GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONTIER GROUP, INC
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:
FRONTIER MEDICAL
Provider Other Organization Name Type Code:
3
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:
1194703710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 E DOWLING RD
Provider Second Line Business Mailing Address:
SUITE 26
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99518-1424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-258-8618
Provider Business Mailing Address Fax Number:
907-563-9291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 E DOWLING RD
Provider Second Line Business Practice Location Address:
SUITE 26
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99518-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-258-8618
Provider Business Practice Location Address Fax Number:
907-563-9291
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOBBS
Authorized Official First Name:
DICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
907-258-8618

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1021833 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1270320001 . This is a "PTAN" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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