Provider Demographics
NPI:1386903045
Name:BLACK HILLS HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:BLACK HILLS HEALTH AND WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-341-7500
Mailing Address - Street 1:1220 MT RUSHMORE RD SUITE 1
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-341-7500
Mailing Address - Fax:605-341-7903
Practice Address - Street 1:114 4TH AVE
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:SD
Practice Address - Zip Code:57790
Practice Address - Country:US
Practice Address - Phone:605-341-7500
Practice Address - Fax:605-341-7903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK HILLS HEALTH AND WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD41557Medicare PIN