Basic Information
| Provider Information | |||||||||
| NPI: | 1972530442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSARIO | ||||||||
| FirstName: | ELMO | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTEN MEDICAL STAFF SERVICES | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577016000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057197109 | ||||||||
| FaxNumber: | 6057191027 | ||||||||
| Practice Location | |||||||||
| Address1: | 2805 5TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057195700 | ||||||||
| FaxNumber: | 6057195701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 08/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 2375 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | P00368653 | 01 | SD | RR MEDICARE | OTHER | 6000633 | 05 | SD | MEDICAID | 2375 | 01 | SD | DAKOTACARE | OTHER | 4993467 | 01 | SD | WELLMARK | OTHER |