Provider Demographics
NPI:1528258555
Name:FRONTERA HEALTHCARE NETWORK
Entity type:Organization
Organization Name:FRONTERA HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:325-869-5500
Mailing Address - Street 1:P.O. BOX 989
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0989
Mailing Address - Country:US
Mailing Address - Phone:325-869-5500
Mailing Address - Fax:325-869-5692
Practice Address - Street 1:551 EAKER STREET
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:TX
Practice Address - Zip Code:76837-0889
Practice Address - Country:US
Practice Address - Phone:325-869-8811
Practice Address - Fax:325-869-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188389401Medicaid
TX188389401Medicaid
TX671865Medicare Oscar/Certification