MEDICARE: FALLON SERVICE, 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	3416L0300X	Land Ambulance	3020	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7075	OTHER	FALLON COMM HEALTH PLAN
2	0006866	OTHER	NEIGHBORHOOD (MEDICAL)
3	0084284	OTHER	AETNA/US HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8101364	OTHER	UNITED HC FSF
7	701068	OTHER	HPHC
8	800058	OTHER	TUFTS
9	996258	OTHER	NETWORK HEALTH
10	1001210	OTHER	BEACON HALTH STRATEGIES
11	590088053	OTHER	RR PALMETTO GBA
12	81-00004	OTHER	EVERCARE
13	001859	OTHER	BLUE CROSS (INDEMNITY)
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	008302865	OTHER	AETNA-EL PASO TX
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	81000003	OTHER	UNITED HEALTHCARE
18	000000005485	OTHER	BMC HEALTHNET PLAN
19	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316047236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLON SERVICE, INC.

Provider Business Mailing Address
First Line	:	111 BROOK RD
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-6528
Country	:	US
Telephone Number	:	617-745-2100
Fax Number	:	617-801-8025

Provider Business Practice Location Address
First Line	:	111 BROOK RD
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-6528
Country	:	US
Telephone Number	:	617-745-2100
Fax Number	:	617-801-8025

Authorized Official
Title or Position	:	EVP & COO
Name	:	MR. PATRICK SEAN TYLER
Credential	:	MBA, MS
Telephone Number	:	617-745-2100

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/03/2014

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