Provider Demographics
NPI:1124208970
Name:WHEELCHAIR SERVICES OF THE BLACK HILLS INC
Entity Type:Organization
Organization Name:WHEELCHAIR SERVICES OF THE BLACK HILLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-341-2577
Mailing Address - Street 1:POST OFFICE BOX 4070
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-4070
Mailing Address - Country:US
Mailing Address - Phone:605-341-2577
Mailing Address - Fax:
Practice Address - Street 1:1130 EAST SAINT JAMES STREET
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-0000
Practice Address - Country:US
Practice Address - Phone:605-341-2577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9030450Medicaid