Provider Demographics
NPI:1003526294
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:
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:
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:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital