Provider Demographics
NPI:1245212877
Name:FAULKTON AREA MEDICAL CENTER
Entity Type:Organization
Organization Name:FAULKTON AREA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BLYTHE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-598-6262
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:1300 OAK STREET
Mailing Address - City:FAULKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57438-0100
Mailing Address - Country:US
Mailing Address - Phone:605-598-6262
Mailing Address - Fax:605-598-4186
Practice Address - Street 1:1300 OAK ST
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-2149
Practice Address - Country:US
Practice Address - Phone:605-598-6262
Practice Address - Fax:605-598-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10539275N00000X, 282N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0159250Medicaid
SD0100210Medicaid
SD5500210Medicaid
SDS32025Medicare PIN
SD431301Medicare PIN
SD431301Medicare Oscar/Certification