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Organization
RUSHMORE AMBULATORY SURGERY CENTER
Active
Organization
RUSHMORE AMBULATORY SURGERY CENTER
Active
Other names
BLACK HILLS PEDIATRIC DENTISTRY SURGERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI J JOBMAN DDS (CEO)
(605) 718-9224
Entity
Organization
Contact information
Practice address
620 SHERIDAN LAKE RD, SUITE 104, RAPID CITY, SD 57702-2406
(605) 341-1314
(605) 341-5757
Mailing address
620 SHERIDAN LAKE RD STE 101, RAPID CITY, SD 57702-2490
(605) 718-9224
(605) 718-9225
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5490450
—
SD
01
—
81022
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA
SD
Enumeration date
05/15/2006
Last updated
08/09/2022
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