Healthcare Provider Details

I. General information

NPI: 1730797184
Provider Name (Legal Business Name): ACUTE CARE SURGERY OF SOUTH DAKOTA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 CAREGIVER CIR
RAPID CITY SD
57702-8529
US

IV. Provider business mailing address

PO BOX 889430
LOS ANGELES CA
90088-9430
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-0400
  • Fax:
Mailing address:
  • Phone: 916-441-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT FLACKS
Title or Position: CFO
Credential:
Phone: 916-441-0400