| Dakota Psychiatry Clinic Pc | |
|
419 Quincy Street Rapid City SD 57701 | |
| (605) 348-6365 | |
| (605) 348-9408 |
| Full Name | Dakota Psychiatry Clinic Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 419 Quincy Street, Rapid City, South Dakota |
| Authorized Official Name and Position | Charles J Lord (PSYCHIATRIST) |
| Authorized Official Contact | 6053486365 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dakota Psychiatry Clinic Pc 419 Quincy Street Rapid City SD 57701 Ph: (605) 348-6365 | Dakota Psychiatry Clinic Pc 419 Quincy Street Rapid City SD 57701 Ph: (605) 348-6365 |
| NPI Number | 1679598320 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5193889954 |
|---|---|
| Medicare Enrollment ID | O20090123000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679598320 | NPI | - | NPPES |
| 4998327 | Other | BCBS | |
| 7100080 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | SD 2247 (South Dakota) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | E2684 (Texas) | Secondary |
| Provider Name | Lisa R Kautzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861462194 PECOS PAC ID: 1254370273 Enrollment ID: I20050428001197 |
| Provider Name | Charles J Lord |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932273190 PECOS PAC ID: 8820152655 Enrollment ID: I20090122000710 |
| Provider Name | Sandra L Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952344699 PECOS PAC ID: 5890988893 Enrollment ID: I20101022000684 |
| Provider Name | Peggy L Oconnor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710235213 PECOS PAC ID: 0042446841 Enrollment ID: I20150921000547 |
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