Healthcare Provider Details

I. General information

NPI: 1871638072
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF THE BLACK HILLC, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 FLORMANN ST STE 100
RAPID CITY SD
57701-4695
US

IV. Provider business mailing address

640 FLORMANN ST STE 100
RAPID CITY SD
57701-4695
US

V. Phone/Fax

Practice location:
  • Phone: 605-718-3219
  • Fax: 605-718-3412
Mailing address:
  • Phone: 605-718-3219
  • Fax: 605-718-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR024930
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCP000457
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3963
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1382
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2150
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5432
License Number StateSD
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4739
License Number StateSD
# 8
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5507
License Number StateSD
# 9
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3563
License Number StateSD
# 10
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4023
License Number StateSD
# 11
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2113
License Number StateSD

VIII. Authorized Official

Name: MISS MELINDA BETH JONES
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 605-178-3219