Provider Demographics
NPI:1669508677
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:RAPID CITY COMMUNITY HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-721-8939
Mailing Address - Street 1:350 PINE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1669
Mailing Address - Country:US
Mailing Address - Phone:605-721-8939
Mailing Address - Fax:605-721-8853
Practice Address - Street 1:350 PINE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1669
Practice Address - Country:US
Practice Address - Phone:605-721-8939
Practice Address - Fax:605-721-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350060Medicaid
SDSD04129S3001OtherMEDICARE PART B
SDSD04129S3000OtherMEDICARE PART B
SD431834Medicare Oscar/Certification
SD431836Medicare Oscar/Certification
SD431839Medicare Oscar/Certification
SD431835Medicare Oscar/Certification
SD5350060Medicaid
SD431812Medicare Oscar/Certification
SDSD04129S3000OtherMEDICARE PART B