MEDICARE: RUSHMORE DERMATOLOGY, 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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1184583726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSHMORE DERMATOLOGY, LLP

Provider Business Mailing Address
First Line	:	2820 MOUNT RUSHMORE RD STE 200
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5462
Country	:	US
Telephone Number	:	605-608-3376
Fax Number	:	605-608-3550

Provider Business Practice Location Address
First Line	:	2820 MOUNT RUSHMORE RD STE 200
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5462
Country	:	US
Telephone Number	:	605-608-3376
Fax Number	:	605-608-3550

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. ROBERT SAGE
Credential	:	MD
Telephone Number	:	605-608-3376

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	05/27/2026

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1407843683 — DR. ANGELA K ANDERSON MD
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