Provider Demographics
NPI:1447840798
Name:FRONTIER MEDICAL ASSOCIATES OF PRESTONSBURG INC
Entity type:Organization
Organization Name:FRONTIER MEDICAL ASSOCIATES OF PRESTONSBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-471-2434
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0697
Mailing Address - Country:US
Mailing Address - Phone:606-886-6622
Mailing Address - Fax:606-886-1173
Practice Address - Street 1:400 UNIVERSITY DR STE 211A
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1080
Practice Address - Country:US
Practice Address - Phone:606-886-6622
Practice Address - Fax:606-886-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100730470Medicaid
KY7100739900Medicaid
KY7100787260Medicaid