| Travis J Ptacek Md Pllc | |
|
529 Kansas City St Ste 203 Rapid City SD 57701-3693 | |
| (605) 223-0011 | |
| Not Available |
| Full Name | Travis J Ptacek Md Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 529 Kansas City St Ste 203, Rapid City, South Dakota |
| Authorized Official Name and Position | Travis Ptacek (PHYSICIAN) |
| Authorized Official Contact | 6052230011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Travis J Ptacek Md Pllc 529 Kansas City St Ste 203 Rapid City SD 57701-3693 Ph: () - | Travis J Ptacek Md Pllc 529 Kansas City St Ste 203 Rapid City SD 57701-3693 Ph: (605) 223-0011 |
| NPI Number | 1265113260 |
|---|---|
| Provider Enumeration Date | 07/31/2023 |
| Last Update Date | 10/16/2024 |
| Medicare PECOS PAC ID | 1658725692 |
|---|---|
| Medicare Enrollment ID | O20230926001029 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265113260 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | Mark J Ptacek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083611958 PECOS PAC ID: 5395654545 Enrollment ID: I20080319000544 |
| Provider Name | Jeanie M Lembke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922054279 PECOS PAC ID: 8325189715 Enrollment ID: I20100107000339 |
| Provider Name | Brenda Vandewater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669847067 PECOS PAC ID: 7315236775 Enrollment ID: I20160525001313 |
| Provider Name | Ashley E Brunmaier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336684372 PECOS PAC ID: 3173807401 Enrollment ID: I20170303001167 |
| Provider Name | Drew Moss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003234097 PECOS PAC ID: 6901194133 Enrollment ID: I20171003004709 |
| Provider Name | Jared C Shippee |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1871637033 PECOS PAC ID: 3678664364 Enrollment ID: I20171219001827 |
| Provider Name | Travis Ptacek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477819944 PECOS PAC ID: 5092087486 Enrollment ID: I20200915002674 |
| Provider Name | Kristina D Jurgensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376240739 PECOS PAC ID: 7012377187 Enrollment ID: I20230720002756 |
| Provider Name | Amanda Michelle Shafer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700344926 PECOS PAC ID: 9931569951 Enrollment ID: I20230721000923 |
| Provider Name | Mckaela K Aghbashian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407534332 PECOS PAC ID: 3971950304 Enrollment ID: I20231107002512 |
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