Healthcare Provider Details

I. General information

NPI: 1720493075
Provider Name (Legal Business Name): FAULKTON AREA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OAK ST
FAULKTON SD
57438-2149
US

IV. Provider business mailing address

BOX 100
FAULKTON SD
57438-0100
US

V. Phone/Fax

Practice location:
  • Phone: 605-598-6262
  • Fax: 605-598-4186
Mailing address:
  • Phone: 605-598-6262
  • Fax: 605-598-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number10539
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number10539
License Number StateSD

VIII. Authorized Official

Name: SUSAN MILLER
Title or Position: CFO
Credential:
Phone: 605-598-6262