Provider Demographics
NPI:1316236136
Name:FRONTLINE MEDICAL INNOVATIONS LLC
Entity type:Organization
Organization Name:FRONTLINE MEDICAL INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-771-7137
Mailing Address - Street 1:4284 TRAIL BOSS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7521
Mailing Address - Country:US
Mailing Address - Phone:303-660-1238
Mailing Address - Fax:303-872-6528
Practice Address - Street 1:4284 TRAIL BOSS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7521
Practice Address - Country:US
Practice Address - Phone:303-660-1238
Practice Address - Fax:303-872-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies