Provider Demographics
NPI:1720195324
Name:FAL RIVER HEALTH CENTER
Entity Type:Organization
Organization Name:FAL RIVER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-781-7880
Mailing Address - Street 1:202 ROUTE 1
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1327
Mailing Address - Country:US
Mailing Address - Phone:207-781-7880
Mailing Address - Fax:207-781-7882
Practice Address - Street 1:202 ROUTE 1
Practice Address - Street 2:SUITE 203
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1327
Practice Address - Country:US
Practice Address - Phone:207-781-7880
Practice Address - Fax:207-781-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEC66296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME033460857OtherTRICARE
ME3443855OtherAETNA HMO
ME2545615OtherCIGNA
MEC66296OtherHARVARD PILGRIM
ME403850000Medicaid
ME022397OtherANTHEM
ME7914559OtherAETNA PPO