1033985809 NPI number — FRONTIER DIRECT CARE BROWNSVILLE SOUTH

Table of content: (NPI 1033985809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033985809 NPI number — FRONTIER DIRECT CARE BROWNSVILLE SOUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONTIER DIRECT CARE BROWNSVILLE SOUTH
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:
Provider Other Organization Name Type Code:
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:
1033985809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 W VAN BUREN AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78550-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-983-9272
Provider Business Mailing Address Fax Number:
956-265-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 N. EXPRESSWAY 77
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-303-8995
Provider Business Practice Location Address Fax Number:
956-265-1053
Provider Enumeration Date:
12/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LAZZOPINA
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF MEDICAL OFFICE
Authorized Official Telephone Number:
302-545-5224

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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