Provider Demographics
NPI:1578564373
Name:GEIB, ELSTON, FROST PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:GEIB, ELSTON, FROST PROFESSIONAL ASSOCIATION
Other - Org Name:CLINICAL LABORATORY OF THE BLACK HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-343-2267
Mailing Address - Street 1:2805 5TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6003
Mailing Address - Country:US
Mailing Address - Phone:605-343-2267
Mailing Address - Fax:605-342-0418
Practice Address - Street 1:2805 5TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6003
Practice Address - Country:US
Practice Address - Phone:605-343-2267
Practice Address - Fax:605-342-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5580110Medicaid
SDS20Medicare PIN
SD5580110Medicaid