NPIMap

Organization Active NPI

Fallon Medical Complex Inc

Doing business as Wibaux Clinic

  • Health Service Clinic/Center
  • Wibaux, MT
National Provider Identifier
1043229776
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
FALLON MEDICAL COMPLEX INC
Doing business as
Wibaux Clinic
Practice address
710 Drake Street
Wibaux, MT 59353
Phone
(406) 778-2833
Fax
(406) 778-5155
NPI assigned
Aug 5, 2006
Last updated
May 9, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
FALLON MEDICAL COMPLEX INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Selena R Nelson
Title
Cfo
Phone
(406) 778-5103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary

Addresses

Primary practice location

710 Drake Street
Wibaux, MT 59353

Mailing address

PO Box 1119
202 South 4TH Street West
Baker, MT 59313-1119
Phone (406) 778-2833

Other names 1

  • Wibaux Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040614000391 MT Part B Supplier - Clinic/Group Practice 0941119499 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baker, MT; Wibaux, MT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1043229776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1119",
            "address_2": "202 SOUTH 4TH STREET WEST",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593131119",
            "telephone_number": "406-778-2833",
            "fax_number": "406-778-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 DRAKE STREET",
            "city": "WIBAUX",
            "state": "MT",
            "postal_code": "59353",
            "telephone_number": "406-778-2833",
            "fax_number": "406-778-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLON MEDICAL COMPLEX INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FALLON MEDICAL COMPLEX INC",
        "enumeration_date": "2006-08-05",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "SELENA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "406-778-5103"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wibaux Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wibaux, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.