Healthcare Provider Details

I. General information

NPI: 1073689915
Provider Name (Legal Business Name): COUNTY OF FALLON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WEST FALLON AVENUE
BAKER MT
59313-0638
US

IV. Provider business mailing address

PO BOX 820
BAKER MT
59313-0820
US

V. Phone/Fax

Practice location:
  • Phone: 406-778-5104
  • Fax: 406-778-5155
Mailing address:
  • Phone: 406-778-5103
  • Fax: 406-778-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

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