Provider Demographics
NPI:1538916226
Name:FALLON TRANSPORT, LLC
Entity type:Organization
Organization Name:FALLON TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MBR
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-281-2083
Mailing Address - Street 1:2793 EAGLE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-5256
Mailing Address - Country:US
Mailing Address - Phone:904-673-9979
Mailing Address - Fax:
Practice Address - Street 1:13420 PARKER COMMONS BLVD STE 106E
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1973
Practice Address - Country:US
Practice Address - Phone:239-281-2083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)