Healthcare Provider Details

I. General information

NPI: 1144155490
Provider Name (Legal Business Name): EXCEPTIONAL PHYSICIANS GROUP RAPID CITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 DYESS AVENUE
RAPID CITY SD
57701
US

IV. Provider business mailing address

3514 CEDAR SPRINGS RD
DALLAS TX
75219-4901
US

V. Phone/Fax

Practice location:
  • Phone: 469-341-7800
  • Fax: 469-807-1208
Mailing address:
  • Phone: 469-341-7800
  • Fax: 469-807-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD IVAN COLLINS
Title or Position: DIRECTOR OF ENROLLMENT
Credential:
Phone: 972-740-9335