Basic Information
| Provider Information | |||||||||
| NPI: | 1770076689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRONTIER RADIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 WATERSONG LANE | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126594467 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3101 HIGHWAY 71E SUITE 108 | ||||||||
| Address2: | |||||||||
| City: | BASTROP | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123320222 | ||||||||
| FaxNumber: | 5123320227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2018 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5126594467 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.