MEDICARE: FALCON HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35.129447	OH

General Provider Information

NPI Number	:	1063913317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALCON HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	1445 HARRISON AVE NW STE 105
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2634
Country	:	US
Telephone Number	:	330-455-4531
Fax Number	:	330-455-0119

Provider Business Practice Location Address
First Line	:	1445 HARRISON AVE NW STE 105
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-2634
Country	:	US
Telephone Number	:	330-455-4531
Fax Number	:	330-455-0119

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANDREW JOHN HERMAN
Credential	:	MD
Telephone Number	:	330-705-7070

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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