Provider Demographics
NPI:1700125259
Name:RAPID CITY REGIONAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:RAPID CITY REGIONAL HOSPITAL, INC.
Other - Org Name:REGIONAL SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO RH, CEO RCRH RHN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGHRUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-719-8162
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-719-7141
Mailing Address - Fax:605-719-7180
Practice Address - Street 1:1906 LOMBARDY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703
Practice Address - Country:US
Practice Address - Phone:605-755-3065
Practice Address - Fax:605-755-3066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-04
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100-19883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0614080004Medicare NSC