Basic Information
| Provider Information | |||||||||
| NPI: | 1841279064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FROST | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1229 C AVE E | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525774246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416723100 | ||||||||
| FaxNumber: | 6416723111 | ||||||||
| Practice Location | |||||||||
| Address1: | 1229 C AVE E | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525774246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416723100 | ||||||||
| FaxNumber: | 6416723111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 07/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 03166 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 2184093 | 05 | IA | MEDICAID | 12006 | 01 | IA | IA BLUE SHIELD PROVIDER N | OTHER | P00169226 | 01 | IA | RR MEDICARE PROVIDER NUMB | OTHER |