Provider Demographics
NPI:1447877386
Name:BLACK HILLS PRIMARY CARE PC
Entity type:Organization
Organization Name:BLACK HILLS PRIMARY CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KINSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHULTZ PIATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-595-2597
Mailing Address - Street 1:2920 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8134
Mailing Address - Country:US
Mailing Address - Phone:605-719-7313
Mailing Address - Fax:605-719-7333
Practice Address - Street 1:2920 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8134
Practice Address - Country:US
Practice Address - Phone:605-719-7313
Practice Address - Fax:605-719-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty