Provider Demographics
NPI:1871638072
Name:MEDICAL ASSOCIATES OF THE BLACK HILLC, LLC.
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF THE BLACK HILLC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-178-3219
Mailing Address - Street 1:640 FLORMANN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4695
Mailing Address - Country:US
Mailing Address - Phone:605-718-3219
Mailing Address - Fax:605-718-3412
Practice Address - Street 1:640 FLORMANN ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4695
Practice Address - Country:US
Practice Address - Phone:605-718-3219
Practice Address - Fax:605-718-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3963207R00000X
SD1382207R00000X
SD2150207R00000X
SD5432207R00000X
SD4739208000000X
SD5507208000000X
SD3563208600000X
SD4023208600000X
SD2113208600000X
SDR024930363LP0200X
SDCP000457363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0008618OtherBCBS OF SD GROUP#
SD0008618OtherBCBS OF SD GROUP#