Provider Demographics
NPI:1518219633
Name:COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-721-8939
Mailing Address - Street 1:350 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-721-8919
Mailing Address - Fax:605-721-8834
Practice Address - Street 1:350 PINE STREET
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-721-8919
Practice Address - Fax:605-721-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty