| Advanced Ent And Allergy Center Of The Black Hills, Prof Llc | |
|
4940 5th St Ste 2b Rapid City SD 57701-6026 | |
| (605) 716-6390 | |
| Not Available |
| Full Name | Advanced Ent And Allergy Center Of The Black Hills, Prof Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4940 5th St Ste 2b, Rapid City, South Dakota |
| Authorized Official Name and Position | Jay Warren White (OWNER) |
| Authorized Official Contact | 6057166390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Ent And Allergy Center Of The Black Hills, Prof Llc 4940 5th St Ste 2b Rapid City SD 57701-6026 Ph: (605) 716-6390 | Advanced Ent And Allergy Center Of The Black Hills, Prof Llc 4940 5th St Ste 2b Rapid City SD 57701-6026 Ph: (605) 716-6390 |
| NPI Number | 1346849478 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 02/08/2021 |
| Medicare PECOS PAC ID | 4082026448 |
|---|---|
| Medicare Enrollment ID | O20201209002408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346849478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Nancy M Gwaltney |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1871516369 PECOS PAC ID: 1052408515 Enrollment ID: I20071030000577 |
| Provider Name | Jay W White |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1023017167 PECOS PAC ID: 3577546902 Enrollment ID: I20091209000381 |
| Provider Name | Robert C Burgess |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1013961978 PECOS PAC ID: 5890702146 Enrollment ID: I20100317000547 |
| Provider Name | Stacie A Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962978528 PECOS PAC ID: 4587909304 Enrollment ID: I20181226002058 |
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