1003145392 NPI number — MONUMENT HEALTH RAPID CITY HOSPITAL, INC.

Table of content: (NPI 1003145392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003145392 NPI number — MONUMENT HEALTH RAPID CITY HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONUMENT HEALTH RAPID CITY HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONUMENT HEALTH DIALYSIS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003145392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 860013
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55486-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-755-2165
Provider Business Mailing Address Fax Number:
605-755-4593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 FAIRMONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701-7375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-719-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MONUMENT HEALTH PRESIDENT
Authorized Official Telephone Number:
605-755-8162

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  10558 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1003145392 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10558 . This is a "SD LICENSE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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