Healthcare Provider Details

I. General information

NPI: 1538128491
Provider Name (Legal Business Name): NEURO SURGICAL & SPINAL SURGERY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 5TH ST
RAPID CITY SD
57701-6021
US

IV. Provider business mailing address

4141 5TH ST
RAPID CITY SD
57701-6021
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-2424
  • Fax: 605-341-4547
Mailing address:
  • Phone: 605-341-2424
  • Fax: 605-341-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0256
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0256
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0256
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0256
License Number StateSD

VIII. Authorized Official

Name: STUART G RICE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 605-341-2424