Provider Demographics
NPI:1629949284
Name:FRONTLINE TELEHEALTH
Entity type:Organization
Organization Name:FRONTLINE TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TYRRELL
Authorized Official - Last Name:BURRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-284-1927
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-0178
Mailing Address - Country:US
Mailing Address - Phone:512-225-5024
Mailing Address - Fax:833-605-4025
Practice Address - Street 1:3211 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1345
Practice Address - Country:US
Practice Address - Phone:512-225-5024
Practice Address - Fax:833-605-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty