Provider Demographics
NPI:1770786741
Name:BRANCH HEALTH CLINIC FALLON
Entity type:Organization
Organization Name:BRANCH HEALTH CLINIC FALLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:937 FRANKLIN AVENUE
Mailing Address - Street 2:UNIFORM BUSINESS OFFICE
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93246-4701
Mailing Address - Country:US
Mailing Address - Phone:559-998-4982
Mailing Address - Fax:559-998-4425
Practice Address - Street 1:477 PASTURE ROAD
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89496-5000
Practice Address - Country:US
Practice Address - Phone:775-426-3105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC LEMOORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient