Provider Demographics
NPI:1659316396
Name:FALL GENERAL SURGERY LLC
Entity Type:Organization
Organization Name:FALL GENERAL SURGERY LLC
Other - Org Name:FALL GENERAL SURGERY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-685-0656
Mailing Address - Street 1:216 3RD ST W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1602
Mailing Address - Country:US
Mailing Address - Phone:715-685-0656
Mailing Address - Fax:715-685-9326
Practice Address - Street 1:216 3RD ST W
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1602
Practice Address - Country:US
Practice Address - Phone:715-685-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34121208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21280100Medicaid
MNC05818OtherMEDICARE PTAN
WIDA5810OtherRAILROAD MEDICARE
WI21280100Medicaid
1659316396OtherNPI
WI21280100Medicaid