MEDICARE: RAPID CITY IHS HOSPITAL

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	282N00000X	General Acute Care Hospital	1265	SD

Other Identifiers

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

General Provider Information

NPI Number	:	1790748226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID CITY IHS HOSPITAL

Provider Business Mailing Address
First Line	:	3200 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8114
Country	:	US
Telephone Number	:	605-355-2282
Fax Number	:	305-355-2504

Provider Business Practice Location Address
First Line	:	3200 CANYON LAKE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8114
Country	:	US
Telephone Number	:	605-355-2282
Fax Number	:	305-355-2504

Authorized Official
Title or Position	:	MEDICAL SOCIAL WORKER
Name	:	MS. JOLENE BLACK LANCE
Credential	:	MSW/LCSW
Telephone Number	:	605-355-2282

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	08/22/2020

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Directions to “RAPID CITY IHS HOSPITAL ” Practice Location

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