Healthcare Provider Details

I. General information

NPI: 1750089439
Provider Name (Legal Business Name): NOLEN INDEPENDENT MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 1/2 MAIN ST STE 2
RAPID CITY SD
57701-2758
US

IV. Provider business mailing address

625 1/2 MAIN ST STE 2
RAPID CITY SD
57701-2758
US

V. Phone/Fax

Practice location:
  • Phone: 605-431-6480
  • Fax:
Mailing address:
  • Phone: 605-431-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARA NOLEN
Title or Position: OWNER / CEO
Credential: MS
Phone: 605-431-6480