Provider Demographics
NPI:1316047236
Name:FALLON SERVICE, INC.
Entity type:Organization
Organization Name:FALLON SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS
Authorized Official - Phone:617-745-2100
Mailing Address - Street 1:111 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6528
Mailing Address - Country:US
Mailing Address - Phone:617-745-2100
Mailing Address - Fax:617-801-8025
Practice Address - Street 1:111 BROOK RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6528
Practice Address - Country:US
Practice Address - Phone:617-745-2100
Practice Address - Fax:617-801-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
7075OtherFALLON COMM HEALTH PLAN
0006866OtherNEIGHBORHOOD (MEDICAL)
0084284OtherAETNA/US HEALTHCARE
NH99908012Medicaid
ME145650000Medicaid
8101364OtherUNITED HC FSF
701068OtherHPHC
800058OtherTUFTS
996258OtherNETWORK HEALTH
1001210OtherBEACON HALTH STRATEGIES
590088053OtherRR PALMETTO GBA
81-00004OtherEVERCARE
001859OtherBLUE CROSS (INDEMNITY)
NY00597535Medicaid
008302865OtherAETNA-EL PASO TX
VT1000183Medicaid
81000003OtherUNITED HEALTHCARE
000000005485OtherBMC HEALTHNET PLAN
MA1700383Medicaid
NH99908012Medicaid