Basic Information
| Provider Information | |||||||||
| NPI: | 1750337069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLACK HILLS OBSTETRICS AND GYNECOLOGY LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 677 CATHEDRAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053439224 | ||||||||
| FaxNumber: | 6053421359 | ||||||||
| Practice Location | |||||||||
| Address1: | 677 CATHEDRAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053439224 | ||||||||
| FaxNumber: | 6053421359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | JAEGER | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6053439224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.