Provider Demographics
NPI:1831249168
Name:FALLA MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:FALLA MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT. SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-979-1100
Mailing Address - Street 1:54 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2208
Mailing Address - Country:US
Mailing Address - Phone:508-979-1100
Mailing Address - Fax:508-979-1918
Practice Address - Street 1:54 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2208
Practice Address - Country:US
Practice Address - Phone:508-979-1100
Practice Address - Fax:508-979-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty