NPI 1497727028 · live from the CMS NPI Registry
Black Hills Dermatology PC
Dermatology in Rapid City, SD. National Provider Identifier 1497727028, active.
NPI record
| NPI | 1497727028 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 7236 Jordan Drive Suite 101, Rapid City, SD 57702 |
| Practice phone | 605-341-5565 |
| Mailing address | 7236 Jordan Drive Suite 101, Po Box 6540, Rapid City, SD 57709 |
| Enumerated | February 7, 2006 |
| Last updated | May 20, 2008 |
| Authorized official | Jason Gorman, Administrator |
| Other names | Black Hills Dermatology And Laser Surgery Centre |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | 0370 (SD) |
| Dermatology, Dermatopathology | 207ND0900X | 0370 (SD) |
| Dermatology, Pediatric Dermatology | 207NP0225X | 0370 (SD) |
| Dermatology primary | 207N00000X | 0370 (SD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.