Provider Demographics
NPI:1083763288
Name:K ALAN KELTS MD STEVEN K HATA MD ROBERT C FINLEY MD ETAL PTRS
Entity Type:Organization
Organization Name:K ALAN KELTS MD STEVEN K HATA MD ROBERT C FINLEY MD ETAL PTRS
Other - Org Name:BLACK HILLS NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-341-3770
Mailing Address - Street 1:2929 5TH ST
Mailing Address - Street 2:STE 240
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7363
Mailing Address - Country:US
Mailing Address - Phone:605-341-3770
Mailing Address - Fax:605-341-8692
Practice Address - Street 1:2929 5TH ST
Practice Address - Street 2:STE 240
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7363
Practice Address - Country:US
Practice Address - Phone:605-341-3770
Practice Address - Fax:605-341-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0000058OtherBC BS
WY102533300Medicaid
SD=========OtherTRICARE
WY102533300Medicaid
NE=========13Medicaid
NENA1296Medicare PIN
SD=========OtherTRICARE