Provider Demographics
NPI:1760465207
Name:PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C.
Entity Type:Organization
Organization Name:PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-343-6714
Mailing Address - Street 1:3615 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6014
Mailing Address - Country:US
Mailing Address - Phone:605-343-6714
Mailing Address - Fax:605-343-2130
Practice Address - Street 1:3615 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6014
Practice Address - Country:US
Practice Address - Phone:605-343-6714
Practice Address - Fax:605-343-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11152261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD81014OtherWELLMARK BCBS #