1760442099 NPI number — NEUROSURGICAL & SPINAL SURGERY ASSOCIATES, P.C.

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 1760442099 NPI number — NEUROSURGICAL & SPINAL SURGERY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL & SPINAL SURGERY ASSOCIATES, P.C.
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:
PROMOTION PHYSICAL THERAPY
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:
1760442099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4141 5TH ST
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:
57701-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-399-9565
Provider Business Mailing Address Fax Number:
605-399-9584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 5TH ST
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:
57701-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-399-9565
Provider Business Practice Location Address Fax Number:
605-399-9584
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
STUART
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-341-2424

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  0256 , 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: 4998880 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 100263804-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142500500 . This is a "OWCP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 27098 . This is a "SANFORD HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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