Healthcare Provider Details

I. General information

NPI: 1487621116
Provider Name (Legal Business Name): MONUMENT HEALTH RAPID CITY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E NORTH ST STE 200
RAPID CITY SD
57701-1745
US

IV. Provider business mailing address

PO BOX 860013
MINNEAPOLIS MN
55486-0013
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-6950
  • Fax: 605-755-6997
Mailing address:
  • Phone: 605-755-6950
  • Fax: 605-755-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number10558
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier82305
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK
# 2
Identifier5550060
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: JOHN PIERCE
Title or Position: MONUMENT HEALTH PRESIDENT
Credential:
Phone: 605-755-8162