Provider Demographics
NPI:1275663213
Name:BLACK HILLS PODIATRY
Entity Type:Organization
Organization Name:BLACK HILLS PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKEA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:605-343-3511
Mailing Address - Street 1:904 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2608
Mailing Address - Country:US
Mailing Address - Phone:605-343-3511
Mailing Address - Fax:605-343-4449
Practice Address - Street 1:904 QUINCY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2608
Practice Address - Country:US
Practice Address - Phone:605-343-3511
Practice Address - Fax:605-343-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD96-SD213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6800060Medicaid
SDT66693Medicare UPIN
SDU90971Medicare UPIN
SD40450Medicare ID - Type UnspecifiedDR. RYDER MCR #
SD0927150001Medicare NSC
SD66019Medicare ID - Type UnspecifiedDR. SKEA'S MCR NUMBER