Provider Demographics
NPI:1306295217
Name:BLACK HILLS SURGICAL HOSPITAL, LLP
Entity type:Organization
Organization Name:BLACK HILLS SURGICAL HOSPITAL, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAUP
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:605-721-4918
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0817
Mailing Address - Country:US
Mailing Address - Phone:605-722-7777
Mailing Address - Fax:605-791-7704
Practice Address - Street 1:120 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1506
Practice Address - Country:US
Practice Address - Phone:605-722-7777
Practice Address - Fax:605-791-7704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK HILLS SURGICAL HOSPITAL, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care