Healthcare Provider Details

I. General information

NPI: 1639229727
Provider Name (Legal Business Name): BLACK HILLS PEDIATRICS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 5TH ST
RAPID CITY SD
57701-7316
US

IV. Provider business mailing address

2905 5TH ST
RAPID CITY SD
57701-7316
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-7337
  • Fax: 605-341-2447
Mailing address:
  • Phone: 605-341-7337
  • Fax: 605-341-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN HASS
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 605-341-7337