Healthcare Provider Details

I. General information

NPI: 1386587095
Provider Name (Legal Business Name): WEST RIVER HV, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ANAMARIA DR
RAPID CITY SD
57701-7305
US

IV. Provider business mailing address

201 ANAMARIA DR
RAPID CITY SD
57701-7305
US

V. Phone/Fax

Practice location:
  • Phone: 605-608-0693
  • Fax:
Mailing address:
  • Phone: 605-608-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY WILSON
Title or Position: OWNER
Credential: MD
Phone: 605-608-0693