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Organization
FRONTERA HEALTHCARE NETWORK, INC.
Active
Organization
FRONTERA HEALTHCARE NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAM KLEIBRINK (CHIEF EXECUTIVE OFFICER FRONTERA HE)
(325) 869-5500
Entity
Organization
Contact information
Practice address
108 SAN SABA AVE., MENARD, TX 76859-0889
(325) 396-2417
(325) 396-2417
Mailing address
P.O. BOX 989, 604 EAKER ST., EDEN, TX 76837-0989
(325) 869-5500
(325) 869-5692
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0026306
TX
261QD0000X
Dental Clinic/Center
24123
TX
261QF0400X
Federally Qualified Health Center (FQHC)
0026306
TX
261QF0400X
Federally Qualified Health Center (FQHC)
24123
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2109480
—
TX
Enumeration date
08/06/2009
Last updated
04/13/2011
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