Individual
JAMES A GAVACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 719-8289
(605) 719-7680
Mailing address
PO BOX 3450, RAPID CITY, SD 57709-3450
(605) 719-8289
(605) 719-7680
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R031455
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0040909
WELLMARK
SD
01
—
430079097
RR MEDICARE
SD
05
—
5753330
—
SD
05
—
5753332
—
SD
Enumeration date
08/26/2006
Last updated
03/08/2008
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