MEDICARE: BLACK HILLS SURGICAL HOSPITAL, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	284300000X	Special Hospital	10582	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	SD01300	OTHER	SD	SUBMITTER ID

General Provider Information

NPI Number	:	1063654176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK HILLS SURGICAL HOSPITAL, LLP

Provider Business Mailing Address
First Line	:	1868 LOMBARDY DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-4130
Country	:	US
Telephone Number	:	605-721-4900
Fax Number	:	605-721-4964

Provider Business Practice Location Address
First Line	:	215 ANAMARIA DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7376
Country	:	US
Telephone Number	:	605-721-4800
Fax Number	:	605-721-4964

Authorized Official
Title or Position	:	SUPERVISOR BILLING & REIMBURSEMENT
Name	:	MS. LORI KONST
Credential	:
Telephone Number	:	605-721-4934

Provider Enumeration Date	:	04/03/2009
Last Update Date	:	10/13/2009

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Directions to “BLACK HILLS SURGICAL HOSPITAL, LLP ” Practice Location

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