Provider Demographics
NPI:1578672705
Name:UROLOGICAL CLINIC OF RAPID CITY, P.C.
Entity Type:Organization
Organization Name:UROLOGICAL CLINIC OF RAPID CITY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-348-1084
Mailing Address - Street 1:2805 FIFTH ST
Mailing Address - Street 2:#220
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-348-1084
Mailing Address - Fax:
Practice Address - Street 1:2805 5TH ST STE 220
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7330
Practice Address - Country:US
Practice Address - Phone:605-348-1084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty