Provider Demographics
NPI:1316013022
Name:FALLON MEDICAL COMPLEX INC
Entity type:Organization
Organization Name:FALLON MEDICAL COMPLEX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-778-5303
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-0820
Mailing Address - Country:US
Mailing Address - Phone:406-778-5103
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:406-778-5105
Practice Address - Fax:406-778-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3100526Medicaid
MT3100526Medicaid