Provider Demographics
NPI:1063913317
Name:FALCON HEALTHCARE, INC.
Entity type:Organization
Organization Name:FALCON HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-705-7070
Mailing Address - Street 1:1445 HARRISON AVE NW STE 105
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2634
Mailing Address - Country:US
Mailing Address - Phone:330-455-4531
Mailing Address - Fax:330-455-0119
Practice Address - Street 1:1445 HARRISON AVE NW STE 105
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2634
Practice Address - Country:US
Practice Address - Phone:330-455-4531
Practice Address - Fax:330-455-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty