Provider Demographics
NPI:1851997704
Name:PENNINGTON COUNTY AUDITOR
Entity Type:Organization
Organization Name:PENNINGTON COUNTY AUDITOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHERIFF
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-394-6113
Mailing Address - Street 1:307 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2828
Mailing Address - Country:US
Mailing Address - Phone:605-394-6116
Mailing Address - Fax:605-716-6102
Practice Address - Street 1:307 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2828
Practice Address - Country:US
Practice Address - Phone:605-394-6116
Practice Address - Fax:605-716-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty