Dominick P Trivisonno (NPI# 1235303801, PAC ID# 3577631811) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL PRACTICE.
| Nation Provider ID (NPI) | 1235303801 |
| PAC ID by PECOS | 3577631811 |
| Professional Enrollment ID | I20081014000156 |
| Full Name | Dominick P Trivisonno |
| Organization Legal Name | FALLON MEDICAL COMPLEX INC |
| Address |
710 Drake St Wibaux MT 59353-9086 |
| Phone Number | 4067962223 |
| Gender | M |
| Medical School | WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1982 |
| Primary Specialty | GENERAL PRACTICE |
| Secondary Specialties | FAMILY PRACTICE |
| Group Practice PAC ID | 0941119499 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 271301 | FALLON MEDICAL COMPLEX HOSPITAL |
| 271347 | HOLY ROSARY HEALTHCARE |
| 270004 | BILLINGS CLINIC HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 202 S 4th St W, Baker, MT 59313-9118 | 4067782833115 | FALLON MEDICAL COMPLEX INC |
| 710 Drake St, Wibaux, MT 59353-9086 | 4067962223 | FALLON MEDICAL COMPLEX INC |
| Organization Legal Name | FALLON MEDICAL COMPLEX INC |
| Physicians | 10 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Carol Lee Hough | Nurse Practitioner | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9156 |
| Darryl M Espeland | General Practice | Fallon Medical Complex Inc | 710 Drake St, Wibaux, MT 59353-9086 |
| Katherine Elizabeth Ernest | Physician Assistant | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9156 |
| Carrie J Haar | Nurse Practitioner | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9156 |
| Brian M Sullivan | Family Medicine | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9156 |
| Travis G Allen | Physician Assistant | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9118 |
| George J Ceremuga | Family Practice | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9118 |
| Leanne R Breihahn | Physician Assistant | Fallon Medical Complex Inc | 710 Drake St, Wibaux, MT 59353-9086 |
| Edna M Streit | Physician Assistant | Fallon Medical Complex Inc | 202 S 4th St W, Baker, MT 59313-9118 |
| Street Address |
710 DRAKE ST |
| City | WIBAUX |
| State | MT |
| Zip | 59353-9086 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Darryl M Espeland | General Practice | Fallon Medical Complex Inc | 710 Drake St, Wibaux, MT 59353-9086 |
| Leanne R Breihahn | Physician Assistant | Fallon Medical Complex Inc | 710 Drake St, Wibaux, MT 59353-9086 |
| City | WIBAUX |
| Zip Code | 59353 |
| Specialty | GENERAL PRACTICE |
| City + Specialty | WIBAUX + GENERAL PRACTICE |
Please comment or provide details below to improve the information on Dominick P Trivisonno.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.