Provider Demographics
NPI:1730317942
Name:BLACK HILLS ULTRASOUND
Entity Type:Organization
Organization Name:BLACK HILLS ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-716-6506
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-0317
Mailing Address - Country:US
Mailing Address - Phone:605-716-6506
Mailing Address - Fax:605-718-9658
Practice Address - Street 1:7170 BRIGHTON ST
Practice Address - Street 2:
Practice Address - City:SUMMERSET
Practice Address - State:SD
Practice Address - Zip Code:57718-9847
Practice Address - Country:US
Practice Address - Phone:605-716-6506
Practice Address - Fax:605-718-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty