1972630275 NPI number — BLACK HILLS SURGICAL HOSPITAL, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972630275 NPI number — BLACK HILLS SURGICAL HOSPITAL, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACK HILLS SURGICAL HOSPITAL, LLP
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:
BLACK HILLS SURGERY CENTER, LLP
Provider Other Organization Name Type Code:
4
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:
1972630275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1868 LOMBARDY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57703-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 ANAMARIA DR
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:
57701-7366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-721-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KONST
Authorized Official First Name:
LORI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SUPERVISOR BILLING & REIMBURSEMENT
Authorized Official Telephone Number:
605-721-4934

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  10582 , 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: 0108020 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5508020 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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