Provider Demographics
NPI:1639229727
Name:BLACK HILLS PEDIATRICS, LLP
Entity Type:Organization
Organization Name:BLACK HILLS PEDIATRICS, LLP
Other - Org Name:BLACK HILLS PEDIATRICS AND NEONATOLOGY, LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-341-7337
Mailing Address - Street 1:2905 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7316
Mailing Address - Country:US
Mailing Address - Phone:605-341-7337
Mailing Address - Fax:605-341-2447
Practice Address - Street 1:2905 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7316
Practice Address - Country:US
Practice Address - Phone:605-341-7337
Practice Address - Fax:605-341-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2117Medicare ID - Type Unspecified