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NPI Code Detail

MEDICARE: BLACK HILLS CHILD PSYCHIATRIC SERVICES

MEDICARE: BLACK HILLS CHILD PSYCHIATRIC SERVICES
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center5576SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861514416
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK HILLS CHILD PSYCHIATRIC SERVICES
Provider Business Mailing Address
First Line : 2920 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-5350
Country : US
Telephone Number : 605-721-1991
Fax Number : 605-348-0479
Provider Business Practice Location Address
First Line : 2920 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-5350
Country : US
Telephone Number : 605-721-1991
Fax Number : 605-348-0479
Authorized Official
Title or Position : OWNER
Name : DR. SUSAN LYNN BUNNELL
Credential : MD
Telephone Number : 605-721-1991
Provider Enumeration Date : 04/04/2007
Last Update Date : 06/12/2008

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Directions to “BLACK HILLS CHILD PSYCHIATRIC SERVICES ” Practice Location

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