Basic Information
| Provider Information | |||||||||
| NPI: | 1043577810 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAPID CITY MEDICAL CENTER LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6020 | ||||||||
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| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577096020 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 E MINNESOTA ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053423280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2012 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | RIDDLE | ||||||||
| AuthorizedOfficialFirstName: | DARREL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6053423280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | CR0392 | 01 | RAILROAD MEDICARE | OTHER |