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General NPI Number Information
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NPI Number | 1538543608
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Entity Type | Individual
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Provider Name | MITCH GRIEVE
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 7220 S HIGHWAY 16
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City | RAPID CITY
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State | SD
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Zip | 57702-8708
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Country | US
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Telephone | 605-341-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6850
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City | RAPID CITY
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State | SD
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Zip | 57709-6850
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Country | US
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Telephone | 605-737-9144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1008
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License Number State | SD
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