Fallon Medical Complex Inc
Organization Active NPI Rural Health Clinic/Center · Baker, MT
NPI 1700895752 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1700895752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FALLON MEDICAL COMPLEX INC
- Practice address
- 202 South 4TH Street West
Baker, MT 59313-1119 - Phone
- (406) 778-2833
- Fax
- (406) 778-5155
- NPI assigned
- Aug 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Selena R Nelson
- Title
- Cfo
- Phone
- (406) 778-5103
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 7
Member organizations 1
Related certifications (CCN) 1
Practitioners 7
-
Spencer Michael Fey, FNP-BC
-
Heidi Swift, MSN, FNP-C
-
Lisa A Langburd, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Rural health clinic certification: CCN 273981
- Legal name
- FALLON MEDICAL COMPLEX INC
- Doing business as
- COMMUNITY CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 1, 1994
- Last certification
- Aug 16, 2022
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 1991 in MT
- Enrollment address
- 202 S 4TH St W
Baker, MT 59313-9156 - Related CCNs
- 271301
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Erin M Lutts |
Corporate Director |
Jun 1, 2023 | |
| David Kirschten |
Corporate Director |
Jan 1, 2023 | |
| Elaine Stanhope |
Corporate Director |
Jan 1, 2023 | |
| David E Espeland |
Corporate Officer |
Aug 5, 1995 | 100% |
| W-2 Managing Employee |
Aug 5, 1995 | ||
| Evelyn K Neary |
Corporate Director |
Jan 1, 2023 | |
| Marjorie M Losing |
Corporate Officer |
May 1, 2017 | 25% |
| W-2 Managing Employee |
Jul 18, 2016 | 25% | |
| Curt Arnell |
Corporate Director |
Mar 2, 2022 | |
| Susan L Stevens |
W-2 Managing Employee |
Apr 1, 2017 | |
| Michele Gray |
Corporate Director |
Jan 1, 2024 | |
| Del Espinosa |
Corporate Director |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051013000381 | MT | Part a Provider - Rural Health Clinic | 0941119499 | Practice locations: Baker, MT |
National Provider Directory
- Tax ID family
- FMC Dba Community Clini
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
202 South 4TH Street West
Baker, MT 59313-1119
Mailing address
PO Box 1119
202 South 4TH Street West
Baker, MT 59313-1119
Phone (406) 778-2833
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 720369 | Medicaid | MT |
Other names
- Community Clinic
Other providers in Baker, MT
- Fallon Medical Complex Inc
- Fallon Medical Complex Inc
- Fallon Medical Complex Inc
- Fallon Medical Complex Inc
- Fallon Medical Complex Inc
- Fallon Medical Complex, Inc
- Fallon Medical Complex, Inc
- Gerald Gamrath
- Carrie Jo Haar
- Amber Elena Hurley
All providers in Baker, MT · Rural Health Clinic/Center in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.