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General NPI Number Information
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NPI Number | 1043229776
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Entity Type | Organization
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Legal Business Name | FALLON MEDICAL COMPLEX INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 710 DRAKE STREET
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City | WIBAUX
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State | MT
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Zip | 59353
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Country | US
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Telephone | 406-778-2833
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Fax | 406-778-5155
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Provider Business Mailing Address
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Address Line | PO BOX 1119 202 SOUTH 4TH STREET WEST
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City | BAKER
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State | MT
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Zip | 59313-1119
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Country | US
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Telephone | 406-778-2833
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Fax | 406-778-5155
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Authorized Official
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Title or Position | CFO
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Name | SELENA R NELSON
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Credential |
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Telephone | 406-778-5103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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