1316047236 NPI number — FALLON SERVICE, INC.

Table of content: (NPI 1316047236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316047236 NPI number — FALLON SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALLON SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316047236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 BROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-6528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-745-2100
Provider Business Mailing Address Fax Number:
617-801-8025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 BROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-6528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-745-2100
Provider Business Practice Location Address Fax Number:
617-801-8025
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TYLER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
SEAN
Authorized Official Title or Position:
EVP & COO
Authorized Official Telephone Number:
617-745-2100

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  3020 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7075 . This is a "FALLON COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0006866 . This is a "NEIGHBORHOOD (MEDICAL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0084284 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 99908012 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145650000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8101364 . This is a "UNITED HC FSF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701068 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800058 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 996258 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1001210 . This is a "BEACON HALTH STRATEGIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590088053 . This is a "RR PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81-00004 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001859 . This is a "BLUE CROSS (INDEMNITY)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00597535 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008302865 . This is a "AETNA-EL PASO TX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000183 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81000003 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000005485 . This is a "BMC HEALTHNET PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700383 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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