| Organization Name: | FRONTERA HEALTHCARE NETWORK |
| NPI Number: | 1801143664 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAM KLEIBRINK (CEO) |
| Mailing Address: | 2010 Nine Rd Brady |
| State: | TX US |
| Postal Code: | 768257210 |
| Phone Number: | 3258698811 |
| Fax Number: | |
| NPI Enumeration Date: | 08/11/2012 |
| NPI Last Update Date: | 08/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |