NPIMap

Organization Active NPI

Frontera Healthcare Network, Inc.

  • General Practice Dentistry
  • Menard, TX
National Provider Identifier
1396976478
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0026306 Issued in TX
Legal business name
FRONTERA HEALTHCARE NETWORK, INC.
Practice address
108 San Saba Ave.
Menard, TX 76859-0889
Phone
(325) 396-2417
Fax
(325) 396-2417
NPI assigned
Aug 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Cam Kleibrink
Title
Chief Executive Officer Frontera He
Phone
(325) 869-5500

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 0026306 TX Primary
Dental Clinic/Center 261QD0000X 24123 TX
Federally Qualified Health Center (FQHC) 261QF0400X 24123 TX
Federally Qualified Health Center (FQHC) 261QF0400X 0026306 TX

Addresses

Primary practice location

108 San Saba Ave.
Menard, TX 76859-0889

Mailing address

P.O. Box 989
604 Eaker St.
Eden, TX 76837-0989
Phone (325) 869-5500

Other identifiers 1

IdentifierTypeStateIssuer
2109480MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Frontera Healthcare Network6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1396976478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 989",
            "address_2": "604 EAKER ST.",
            "city": "EDEN",
            "state": "TX",
            "postal_code": "768370989",
            "telephone_number": "325-869-5500",
            "fax_number": "325-869-5692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 SAN SABA AVE.",
            "city": "MENARD",
            "state": "TX",
            "postal_code": "768590889",
            "telephone_number": "325-396-2417",
            "fax_number": "325-396-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRONTERA HEALTHCARE NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-06",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "KLEIBRINK",
        "authorized_official_first_name": "CAM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER FRONTERA HE",
        "authorized_official_telephone_number": "325-869-5500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "0026306",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "24123",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "24123",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "0026306",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2109480",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menard, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.