Provider Demographics
NPI:1033188594
Name:RICE, STUART GLEN (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:GLEN
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6021
Mailing Address - Country:US
Mailing Address - Phone:605-341-2424
Mailing Address - Fax:605-341-4547
Practice Address - Street 1:4141 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6021
Practice Address - Country:US
Practice Address - Phone:605-341-2424
Practice Address - Fax:605-341-4547
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4708207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND22521OtherND BCBS PROVIDER NUMBER
SD6100650Medicaid
SD0007348OtherWELLMARK BCBS PROVIDER #
ND22521OtherND BCBS PROVIDER NUMBER
SD0007348OtherWELLMARK BCBS PROVIDER #
SDS7348Medicare PIN
0977050001Medicare NSC