Healthcare Provider Details

I. General information

NPI: 1760442099
Provider Name (Legal Business Name): NEUROSURGICAL & SPINAL SURGERY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/08/2015
Certification Date:
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: 605-399-9565
  • Fax: 605-399-9584
Mailing address:
  • Phone: 605-399-9565
  • Fax: 605-399-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0256
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier4998880
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK
# 2
Identifier100263804-00
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer
# 3
Identifier142500500
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerOWCP
# 4
Identifier27098
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSANFORD HEALTH

VIII. Authorized Official

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