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General NPI Number Information
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NPI Number | 1124184510
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Entity Type | Organization
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Legal Business Name | RUSHMORE CLINIC, P.C.
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 101 E MINNESOTA ST SUITE 260
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City | RAPID CITY
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State | SD
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Zip | 57701-7756
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Country | US
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Telephone | 605-718-7450
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Fax | 605-718-7465
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Provider Business Mailing Address
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Address Line | 101 E MINNESOTA ST SUITE 260
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City | RAPID CITY
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State | SD
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Zip | 57701-7756
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Country | US
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Telephone | 605-718-7450
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Fax | 605-718-7465
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | VICKY L KRAUSE
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Credential |
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Telephone | 605-718-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0348
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1584
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License Number State | SD
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