Provider Demographics
NPI:1023057478
Name:FALLON TRIBAL HEALTH CENTER
Entity type:Organization
Organization Name:FALLON TRIBAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:PISHION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-423-3634
Mailing Address - Street 1:1001 RIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-5463
Mailing Address - Country:US
Mailing Address - Phone:775-423-3634
Mailing Address - Fax:775-423-2287
Practice Address - Street 1:1001 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-5463
Practice Address - Country:US
Practice Address - Phone:775-423-3634
Practice Address - Fax:775-423-3246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALLON PAIUTE-SHOSHONE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV701001Medicaid
NV00470100100Medicaid
NV291816Medicare Oscar/Certification
NV701001Medicaid