FRONTIER HEALTH NPI 1386700383

NPI Information

NPI: 1386700383
Provider Name: FRONTIER HEALTH

Doing Business As: WATAUGA BEHAVIORAL HEALTH SERVICES

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
109 W WATAUGA AVE
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 232-2600
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FRONTIER HEALTH is a mental health (including community mental health center) clinic center in Johnson City, TN. FRONTIER HEALTH NPI is 1386700383. The provider is registered as an organization entity type.
The provider Is Doing Business As Watauga Behavioral Health Services.

The provider's business location address is:

109 W WATAUGA AVE
JOHNSON CITY, TN
ZIP 37604-621
Phone: (423) 232-2600
Fax: (423) 232-2646

The provider's authorized official is Teresa M Kidd .
The authorized official title is President And Ceo and has the following contact phone number (423) 467-3600.

The CLIA number assigned to this NPI record is 44D2261564 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 12/12/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251B00000X	Case Management		L 214-076-1430	TENNESSEE	No
2	251S00000X	Community/Behavioral Health		L 214-076-1430	TENNESSEE	No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	325	TENNESSEE	No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	L 214-076-1430	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	49-4911-1	MEDICAID	VIRGINIA
2	SAME AS MEDICARE #S	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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