Provider Demographics
NPI:1356447452
Name:SCOTT E. FAULKNER, M.D., PC
Entity type:Organization
Organization Name:SCOTT E. FAULKNER, M.D., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-542-0360
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-0117
Mailing Address - Country:US
Mailing Address - Phone:970-542-0360
Mailing Address - Fax:970-542-0366
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2130
Practice Address - Country:US
Practice Address - Phone:970-542-0360
Practice Address - Fax:970-542-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82506779Medicaid
CO110235029OtherRAILROAD MEDICARE
CO82506779Medicaid
COH43255Medicare UPIN