Frontier Health
Organization Active NPI Adult Mental Health Clinic/Center · Bristol, TN
NPI 1821154352 · NPPES record last updated Aug 1, 2019
Key facts
- NPI
- 1821154352
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Mental Health Clinic/Center 261QM0850X
- License
- L 214-076-1428 (TN)
- Legal business name
- FRONTIER HEALTH
- Practice address
- 266 North St
Bristol, TN 37620-1660 - Phone
- (423) 989-4558
- Fax
- (423) 989-4570
- NPI assigned
- Dec 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Robin Denise Denton, BSOM
- Title
- Um Coordinator
- Phone
- (423) 467-3600
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 20
Practitioners 28
-
Linda J Barger, APRN BC
-
Sarah Lynn Dysarczyk, B.A.
-
Stephen Lloyd Haile, APN
-
Wendy Sturgill Hall, BSW
-
Shannon M Jones, BS
-
Kyle Eugene Mason, BSW
-
Heather B Mays, BS
-
Jenna Nichole Phillips, LMSW
-
Kara Anne Stefko, BA
-
Judy Gertrude Stout, BSW
-
Randall Paul Weaver, MSW LCSW 3920
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | L 214-076-1428 | TN | |
| Community/Behavioral Health Agency | 251S00000X | L 214-076-1428 | TN | |
| Adult Mental Health Clinic/Center | 261QM0850X | L 214-076-1428 | TN | Yes |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | L 214-076-1428 | TN |
Addresses
Primary practice location
266 North St
Bristol, TN 37620-1660
Mailing address
PO Box 9054
Gray, TN 37615-9054
Phone (423) 467-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3920247 | Medicaid | TN |
Other names
- Tennessee Community Support Services
Other providers in Bristol, TN
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Frontier Health
- Katy Fuqua Fuqua
- Paige Clifton Furrow
- Sonja L Furse
- Further Physiotherapy, LLC
All providers in Bristol, TN · Adult Mental Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2019. 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.