Healthcare Provider Details

I. General information

NPI: 1043229776
Provider Name (Legal Business Name): FALLON MEDICAL COMPLEX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 DRAKE STREET
WIBAUX MT
59353
US

IV. Provider business mailing address

PO BOX 1119 202 SOUTH 4TH STREET WEST
BAKER MT
59313-1119
US

V. Phone/Fax

Practice location:
  • Phone: 406-778-2833
  • Fax: 406-778-5155
Mailing address:
  • Phone: 406-778-2833
  • Fax: 406-778-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

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