Provider Demographics
NPI:1912024001
Name:PROFESSIONAL MEDICAL CONSULTANTS PC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:605-737-7777
Mailing Address - Street 1:PO BOX 2652
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2652
Mailing Address - Country:US
Mailing Address - Phone:605-737-7777
Mailing Address - Fax:605-737-7778
Practice Address - Street 1:550 N 5TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1375
Practice Address - Country:US
Practice Address - Phone:605-737-7777
Practice Address - Fax:605-737-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4786207RI0200X
SD47852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0453OtherSTATE LICENSE NUMBER
SD0453OtherSTATE LICENSE NUMBER