Provider Demographics
NPI:1770674491
Name:FAULKNER HEALTH CORPORATION
Entity Type:Organization
Organization Name:FAULKNER HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:417-343-5401
Mailing Address - Street 1:222 SOUTH FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4504
Mailing Address - Country:US
Mailing Address - Phone:479-286-5042
Mailing Address - Fax:479-464-8098
Practice Address - Street 1:222 SOUTH FIRST STREET
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-4504
Practice Address - Country:US
Practice Address - Phone:479-286-5042
Practice Address - Fax:479-464-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR002351332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0878650001Medicare NSC