Healthcare Provider Details

I. General information

NPI: 1275663213
Provider Name (Legal Business Name): BLACK HILLS PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 QUINCY ST
RAPID CITY SD
57701-2608
US

IV. Provider business mailing address

904 QUINCY ST
RAPID CITY SD
57701-2608
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-3511
  • Fax: 605-343-4449
Mailing address:
  • Phone: 605-343-3511
  • Fax: 605-343-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number96-SD
License Number StateSD

VIII. Authorized Official

Name: DR. NEIL SKEA
Title or Position: OWNER
Credential: DPM
Phone: 605-343-3511