Organization
BLACK HILLS SURGICAL HOSPITAL, LLP
Active
Other names
West River Ear, Nose, and Throat
Organization subpart
No
Provider details
NPI number
Authorized official
JACK KAUP (CFO)
(605) 721-4918
Entity
Organization
Contact information
Practice address
1868 LOMBARDY DR, RAPID CITY, SD 57703-4130
(605) 721-4900
(605) 721-4964
Mailing address
1868 LOMBARDY DR, RAPID CITY, SD 57703-4130
(605) 721-4900
(605) 721-4964
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9104
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0108020
—
SD
05
—
5508020
—
SD
Enumeration date
05/16/2016
Last updated
09/01/2016
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