Provider Demographics
NPI:1073356747
Name:BLACK HILLS FAMILY PRACTICE AND WELLNESS LLC
Entity type:Organization
Organization Name:BLACK HILLS FAMILY PRACTICE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TUZSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:605-720-4520
Mailing Address - Street 1:16401 ATALL RD
Mailing Address - Street 2:
Mailing Address - City:UNION CENTER
Mailing Address - State:SD
Mailing Address - Zip Code:57787-8420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 BALLPARK RD STE 3
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2208
Practice Address - Country:US
Practice Address - Phone:605-720-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty