Provider Demographics
NPI:1063654176
Name:BLACK HILLS SURGICAL HOSPITAL, LLP
Entity Type:Organization
Organization Name:BLACK HILLS SURGICAL HOSPITAL, LLP
Other - Org Name:BLACK HILLS IMAGING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR BILLING & REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KONST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-721-4934
Mailing Address - Street 1:1868 LOMBARDY DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-4130
Mailing Address - Country:US
Mailing Address - Phone:605-721-4900
Mailing Address - Fax:605-721-4964
Practice Address - Street 1:215 ANAMARIA DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7376
Practice Address - Country:US
Practice Address - Phone:605-721-4800
Practice Address - Fax:605-721-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10582284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5508020Medicaid
SD0108020Medicaid
SDSD01300OtherSUBMITTER ID
SD5508020Medicaid
SD430091Medicare Oscar/Certification