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General NPI Number Information
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NPI Number | 1992637094
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Entity Type | Organization
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Legal Business Name | WEST RIVER MEN'S HEALTH PC
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 1301 W OMAHA ST STE 224
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City | RAPID CITY
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State | SD
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Zip | 57701-2421
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Country | US
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Telephone | 605-204-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 W OMAHA ST STE 224
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City | RAPID CITY
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State | SD
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Zip | 57701-2421
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Country | US
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Telephone | 605-204-6757
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NICK FLAGELLA
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Credential |
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Telephone | 605-204-6757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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