Organization
BLACK HILLS UROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVONNE CULVER (ADMINISTRATOR)
(605) 348-4100
Entity
Organization
Contact information
Practice address
710 SAINT ANNE ST, RAPID CITY, SD 57701-4670
(605) 348-4100
(605) 348-0662
Mailing address
710 SAINT ANNE ST, RAPID CITY, SD 57701-4670
(605) 348-4100
(605) 348-0662
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003536
BLUE CROSS BLUE SHIELD
SD
01
—
9239296
DAKOTACARE
SD
01
—
CG0319
RAILROAD MEDICARE
SD
Enumeration date
08/30/2006
Last updated
09/19/2007
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