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General NPI Number Information
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NPI Number | 1376896621
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Entity Type | Organization
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Legal Business Name | BLACK HILLS SURGICAL HOSPITAL, LLC
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1868 LOMBARDY DR
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City | RAPID CITY
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State | SD
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Zip | 57703-4130
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Country | US
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Telephone | 605-721-4900
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Fax | 605-721-4964
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Provider Business Mailing Address
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Address Line | 1868 LOMBARDY DR
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City | RAPID CITY
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State | SD
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Zip | 57703-4130
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Country | US
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Telephone | 605-721-4900
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Fax | 605-721-4964
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Authorized Official
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Title or Position | HIM MANAGER
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Name | MS. SUE SMITH
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Credential |
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Telephone | 605-721-4907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 10582
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 10582
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License Number State | SD
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