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NPI Code Detail

MEDICARE: R. P. RENKA, M.D.,P.C.

MEDICARE: R. P. RENKA, M.D.,P.C.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)0133SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770660714
Entity Type Code : Organization
Provider Name (Legal Business Name) : R. P. RENKA, M.D.,P.C.
Provider Business Mailing Address
First Line : 528 QUINCY ST
Second Line : P O BOX 288
City : RAPID CITY
State : SD
Zip : 57701-3628
Country : US
Telephone Number : 605-348-5401
Fax Number : 605-348-7319
Provider Business Practice Location Address
First Line : 528 QUINCY ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-3628
Country : US
Telephone Number : 605-348-5401
Fax Number : 605-348-7319
Authorized Official
Title or Position : PRESIDENT
Name : DR. RICHARD PIERCE RENKA
Credential : MD
Telephone Number : 605-348-5401
Provider Enumeration Date : 11/01/2006
Last Update Date : 11/08/2007

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