Provider Demographics
NPI:1770660714
Name:R. P. RENKA, M.D.,P.C.
Entity Type:Organization
Organization Name:R. P. RENKA, M.D.,P.C.
Other - Org Name:BLACK HILLS PSYCHIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:RENKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-348-5401
Mailing Address - Street 1:528 QUINCY ST
Mailing Address - Street 2:P O BOX 288
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3628
Mailing Address - Country:US
Mailing Address - Phone:605-348-5401
Mailing Address - Fax:605-348-7319
Practice Address - Street 1:528 QUINCY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3628
Practice Address - Country:US
Practice Address - Phone:605-348-5401
Practice Address - Fax:605-348-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0133261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7100070Medicaid
SDS4062Medicare ID - Type Unspecified
SDD25567Medicare UPIN