Organization
ADVANCED DERMATOLOGY OF THE BLACK HILLS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN DEAN MEDECK PA-C (OWNER/PHYSICIAN'S ASSISTANT)
(605) 381-6082
Entity
Organization
Contact information
Practice address
710 SAINT ANNE ST, RAPID CITY, SD 57701-4670
(605) 343-8000
(605) 343-8262
Mailing address
PO BOX 1473, RAPID CITY, SD 57709-1473
(605) 721-0596
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/02/2022
Last updated
02/02/2022
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