MEDICARE: QUEEN CITY MEDICAL CENTER

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1619949161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEEN CITY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1420 N 10TH STREET
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 N 10TH ST
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1532
Country	:	US
Telephone Number	:	605-642-8414
Fax Number	:

Authorized Official
Title or Position	:	ADM ASST
Name	:	KELLY LESTER
Credential	:
Telephone Number	:	605-642-8414

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	12/20/2007

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Directions to “QUEEN CITY MEDICAL CENTER ” Practice Location

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