Healthcare Provider Details

I. General information

NPI: 1659420727
Provider Name (Legal Business Name): THE ENDOSCOPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 MOUNT RUSHMORE RD
RAPID CITY SD
57701-5462
US

IV. Provider business mailing address

2820 MOUNT RUSHMORE RD
RAPID CITY SD
57701-5462
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-8121
  • Fax: 605-721-8425
Mailing address:
  • Phone: 605-721-8121
  • Fax: 605-721-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number53001EUT001
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier81015
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBLUE CROSS BLUE SHIELD SD
# 2
Identifier5490230
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: DR. MICHAEL P. MCGUIRE
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 605-721-8121