Provider Demographics
NPI:1235532326
Name:RAPID CITY REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:RAPID CITY REGIONAL HOSPITAL INC
Other - Org Name:REGIONAL HOME INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT RAPID CITY MARKET
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLEMMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-755-8103
Mailing Address - Street 1:PO BOX 860013
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0013
Mailing Address - Country:US
Mailing Address - Phone:605-755-7649
Mailing Address - Fax:
Practice Address - Street 1:224 ELK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7359
Practice Address - Country:US
Practice Address - Phone:605-755-1150
Practice Address - Fax:605-755-1151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAPID CITY REGIONAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-02
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD105583336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD10558OtherRCRH LICENSE
SD0614080005Medicare NSC