Healthcare Provider Details

I. General information

NPI: 1992637094
Provider Name (Legal Business Name): WEST RIVER MEN'S HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W OMAHA ST STE 224
RAPID CITY SD
57701-2421
US

IV. Provider business mailing address

1301 W OMAHA ST STE 224
RAPID CITY SD
57701-2421
US

V. Phone/Fax

Practice location:
  • Phone: 605-204-6757
  • Fax:
Mailing address:
  • Phone: 605-204-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICK FLAGELLA
Title or Position: MANAGER
Credential:
Phone: 605-204-6757