Provider Demographics
NPI:1194051300
Name:FRONTIER MEDICAL DEVICES
Entity type:Organization
Organization Name:FRONTIER MEDICAL DEVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-363-7960
Mailing Address - Street 1:7868 OLD LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1728
Mailing Address - Country:US
Mailing Address - Phone:314-363-7960
Mailing Address - Fax:
Practice Address - Street 1:7868 OLD LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1728
Practice Address - Country:US
Practice Address - Phone:314-363-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier