MEDICARE: DEBRA FAULKNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225217243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA FAULKNER

Provider Business Mailing Address
First Line	:	532 W FAULKNER ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4519
Country	:	US
Telephone Number	:	870-862-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 W FAULKNER ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4519
Country	:	US
Telephone Number	:	870-862-2000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBRA KAY FAULKNER
Credential	:	R.T.
Telephone Number	:	870-862-2000

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	06/17/2008

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