Provider Demographics
NPI:1316965346
Name:FALLON MEDICAL COMPLEX INC
Entity type:Organization
Organization Name:FALLON MEDICAL COMPLEX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-778-5103
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:202 SOUTH 4TH STREET WEST
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-0820
Mailing Address - Country:US
Mailing Address - Phone:406-778-3331
Mailing Address - Fax:406-778-5155
Practice Address - Street 1:202 SOUTH 4TH STREET WEST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313-0820
Practice Address - Country:US
Practice Address - Phone:406-778-3331
Practice Address - Fax:406-778-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10663282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0412360Medicaid
MT000060632OtherCAH BLUE CROSS
MT0412360Medicaid