Healthcare Provider Details

I. General information

NPI: 1023174521
Provider Name (Legal Business Name): FALLON MEDICAL COMPLEX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH 4TH STREET WEST
BAKER MT
59313-0820
US

IV. Provider business mailing address

PO BOX 820
BAKER MT
59313-0820
US

V. Phone/Fax

Practice location:
  • Phone: 406-778-3331
  • Fax: 406-778-5155
Mailing address:
  • Phone: 406-778-3331
  • Fax: 406-778-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10663
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number10663
License Number StateMT

VIII. Authorized Official

Name: SELENA R NELSON
Title or Position: CFO
Credential:
Phone: 406-778-5103