Provider Demographics
NPI:1912188392
Name:VIRGIL W FAULKNER
Entity Type:Organization
Organization Name:VIRGIL W FAULKNER
Other - Org Name:ACME ORTHOPEDIC LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-733-1802
Mailing Address - Street 1:2411 NE LOOP 410
Mailing Address - Street 2:112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6644
Mailing Address - Country:US
Mailing Address - Phone:210-655-5227
Mailing Address - Fax:210-646-0595
Practice Address - Street 1:2411 NE LOOP 410
Practice Address - Street 2:112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6644
Practice Address - Country:US
Practice Address - Phone:210-655-5227
Practice Address - Fax:210-646-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3160335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167924302Medicaid
TX5145480001Medicare NSC