Basic Information
Provider Information
NPI: 1730568957
EntityType: 2
ReplacementNPI:  
OrganizationName: MONUMENT HEALTH RAPID CITY HOSPITAL, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: MONUMENT HEALTH RAPID CITY URGENT CARE, JACKSON BOULEVARD
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 860013
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554860013
CountryCode: US
TelephoneNumber: 6057552273
FaxNumber: 6057553902
Practice Location
Address1: 2116 JACKSON BLVD
Address2:  
City: RAPID CITY
State: SD
PostalCode: 577023495
CountryCode: US
TelephoneNumber: 6057552273
FaxNumber: 6057553902
Other Information
ProviderEnumerationDate: 05/20/2015
LastUpdateDate: 02/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PIERCE
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MONUMENT HEALTH PRESIDENT
AuthorizedOfficialTelephone: 6057558162
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  N HospitalsGeneral Acute Care Hospital 
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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