MEDICARE: RUSHMORE OB-GYN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4997309	OTHER	SD	BC/BS GROUP #

General Provider Information

NPI Number	:	1316050214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSHMORE OB-GYN PC

Provider Business Mailing Address
First Line	:	3006 TOWER RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5392
Country	:	US
Telephone Number	:	605-343-7295
Fax Number	:	605-343-0138

Provider Business Practice Location Address
First Line	:	3006 TOWER RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5392
Country	:	US
Telephone Number	:	605-343-7295
Fax Number	:	605-343-0138

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	PAMELA A SCHMAGEL
Credential	:	MD
Telephone Number	:	605-343-7295

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/03/2015

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