Provider Demographics
NPI:1417012170
Name:INTERNAL MEDICINE AND GERIATRICS ASSOCIATES, LLP
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND GERIATRICS ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:605-718-4380
Mailing Address - Street 1:PO BOX 8048
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-8048
Mailing Address - Country:US
Mailing Address - Phone:605-718-4380
Mailing Address - Fax:605-718-4396
Practice Address - Street 1:909 SAINT JOSEPH ST
Practice Address - Street 2:SUITE B100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2414
Practice Address - Country:US
Practice Address - Phone:605-718-4380
Practice Address - Fax:605-718-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-23
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2417207RG0300X
SD3651207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000642Medicaid
SD6000262Medicaid
SD6000262Medicaid
SDF92926Medicare UPIN
SDD25588Medicare UPIN