1881033579 NPI number — RAPID CITY MEDICA CENTER LLP

Table of content: (NPI 1881033579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881033579 NPI number — RAPID CITY MEDICA CENTER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAPID CITY MEDICA CENTER 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:
MEDICAL ARTS CLINIC AT RAPID CITY MEDICAL CENTER LLP
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:
1881033579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6020
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:
57709-6020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-342-3280
Provider Business Mailing Address Fax Number:
605-721-8458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 SAINT FRANCIS 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:
57701-4677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-342-2880
Provider Business Practice Location Address Fax Number:
605-388-4617
Provider Enumeration Date:
06/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RIDDLE
Authorized Official First Name:
DARREL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
605-342-3280

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CR0392 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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