NPI 1669125241 · live from the CMS NPI Registry
Advanced Dermatology Of The Black Hills, PC
Physician Assistant in Rapid City, SD. National Provider Identifier 1669125241, active.
NPI record
| NPI | 1669125241 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 710 Saint Anne St, Rapid City, SD 57701 |
| Practice phone | 605-343-8000 |
| Mailing address | Po Box 1473, Rapid City, SD 57709 |
| Enumerated | February 2, 2022 |
| Last updated | February 2, 2022 |
| Authorized official | Jonathan Medeck, Owner/Physician'S Assistant |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology | 207N00000X | — |
| Physician Assistant primary | 363A00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.