Provider Demographics
NPI:1962748939
Name:FRONTIER FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:FRONTIER FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCMILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-682-3333
Mailing Address - Street 1:709 W 8TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4125
Mailing Address - Country:US
Mailing Address - Phone:307-682-3333
Mailing Address - Fax:
Practice Address - Street 1:709 W 8TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4125
Practice Address - Country:US
Practice Address - Phone:307-682-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty