Provider Demographics
NPI:1710582903
Name:GREAT PLAINS GERIATRICS LLC
Entity Type:Organization
Organization Name:GREAT PLAINS GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-281-6172
Mailing Address - Street 1:135 PONDEROSA AVE
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-6057
Mailing Address - Country:US
Mailing Address - Phone:612-987-1090
Mailing Address - Fax:
Practice Address - Street 1:135 PONDEROSA AVE
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-6057
Practice Address - Country:US
Practice Address - Phone:612-987-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty