Provider Demographics
NPI:1902089550
Name:COUNTY OF FALLON
Entity Type:Organization
Organization Name:COUNTY OF FALLON
Other - Org Name:FALLON COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FALLON COUNTY CLERK AND RECORDER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-778-7106
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:406-778-2824
Mailing Address - Fax:406-778-2819
Practice Address - Street 1:205 S 4TH STREET W
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:406-778-2824
Practice Address - Fax:406-778-2819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FALLON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT31663251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare