Frontier Health
Organization Active NPI Community/Behavioral Health Agency · Kingsport, TN
NPI 1700940251 · NPPES record last updated Oct 4, 2018
Key facts
- NPI
- 1700940251
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- L 214-076-1418 (TN)
- Legal business name
- FRONTIER HEALTH
- Practice address
- 1570 Waverly Rd
Kingsport, TN 37664-2523 - Phone
- (423) 224-1300
- Fax
- (423) 224-1375
- NPI assigned
- Dec 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Teresa M Kidd, PHD
- Title
- President and Ceo
- Phone
- (423) 467-3600
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 24
Practitioners 2
-
Tricia Cannon, PMHNP-BC
-
Rajesh Shivaji Kadam, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040109000560 | TN | Part B Supplier - Clinic/Group Practice | 2860302320 |
Receives reassigned benefits from 124 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bristol, TN; Sneedville, TN; Rogersville, TN; Mountain City, TN; Kingsport, TN; Johnson City, TN; Greeneville, TN; Gray, TN… |
National Provider Directory
- Tax ID family
- Lee County Integrated Care
Locations
1145 Volunteer Pkwy
Bristol, TN 37620
Phone (423) 989-4500
616 E Church St
Greeneville, TN 37745
Phone (423) 638-4540
101 Lena Dr
Rogersville, TN 37857
Phone (423) 272-9239
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | L 214-076-1418 | TN | |
| Community/Behavioral Health Agency | 251S00000X | L 214-076-1418 | TN | Yes |
| Adult Mental Health Clinic/Center | 261QM0850X | L 214-076-1418 | TN | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 364 | TN |
Addresses
Primary practice location
1570 Waverly Rd
Kingsport, TN 37664-2523
Mailing address
PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49-4916-1 | Medicaid | TN | |
| SAME AS MEDICARE #S | Medicaid | TN |
Other names
- Holston Counseling Center
Other providers in Kingsport, TN
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontline Wellness Center PLLC
All providers in Kingsport, TN · Community/Behavioral Health Agency in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.