Provider Demographics
NPI:1003434721
Name:BLACK HILLS OBSTETRICS & GYNECOLOGY LLC
Entity Type:Organization
Organization Name:BLACK HILLS OBSTETRICS & GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC/NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BACHMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-343-9224
Mailing Address - Street 1:6015 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8962
Mailing Address - Country:US
Mailing Address - Phone:605-343-9224
Mailing Address - Fax:605-342-1359
Practice Address - Street 1:6015 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8962
Practice Address - Country:US
Practice Address - Phone:605-343-9224
Practice Address - Fax:605-342-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty