MEDICARE: FAULKNER HEALTH CORPORATION

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	332B00000X	Durable Medical Equipment & Medical Supplies	002351	AR

General Provider Information

NPI Number	:	1770674491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAULKNER HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	222 SOUTH FIRST STREET
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4504
Country	:	US
Telephone Number	:	479-286-5042
Fax Number	:	479-464-8098

Provider Business Practice Location Address
First Line	:	222 SOUTH FIRST STREET
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4504
Country	:	US
Telephone Number	:	479-286-5042
Fax Number	:	479-464-8098

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	MRS. PHYLLIS A STAYTON
Credential	:	R.N.
Telephone Number	:	417-343-5401

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/22/2009

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