=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457730673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONUMENT HEALTH RAPID CITY HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2015
-----------------------------------------------------
Last Update Date | 03/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 7TH AVENUE
-----------------------------------------------------
City | WALL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57790-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-279-2149
-----------------------------------------------------
Fax | 605-279-1027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 860013
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55486-0013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-279-2149
-----------------------------------------------------
Fax | 605-279-1027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MONUMENT HEALTH PRESIDENT
-----------------------------------------------------
Name | JOHN PIERCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-755-8162
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------