Provider Demographics
NPI:1841283686
Name:BADE, PRISCILLA FAITH (MD)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:FAITH
Last Name:BADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTN MSS
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-755-8107
Mailing Address - Fax:
Practice Address - Street 1:224 ELK ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7359
Practice Address - Country:US
Practice Address - Phone:605-755-7710
Practice Address - Fax:605-755-0700
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3651207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000262Medicaid
SD40057Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SD6000262Medicaid