Healthcare Provider Details

I. General information

NPI: 1245212877
Provider Name (Legal Business Name): FAULKTON AREA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OAK ST
FAULKTON SD
57438-2149
US

IV. Provider business mailing address

PO BOX 100 1300 OAK STREET
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 TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number10539
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number10539
License Number StateSD

VIII. Authorized Official

Name: BLYTHE K SMITH
Title or Position: CREDENTIALING
Credential:
Phone: 605-598-6262