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2920 W Main St Rapid City SD 57702-8134 | |
| (605) 719-7313 | |
| (605) 719-7333 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2920 W Main St, Rapid City, South Dakota |
| Authorized Official Name and Position | Kinsey A Shultz Piatz (SOLE MEMBER) |
| Authorized Official Contact | 7015952597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2920 W Main St Rapid City SD 57702-8134 Ph: (605) 719-7313 | 2920 W Main St Rapid City SD 57702-8134 Ph: (605) 719-7313 |
| NPI Number | 1447877386 |
|---|---|
| Provider Enumeration Date | 06/26/2020 |
| Last Update Date | 06/03/2024 |
| Medicare PECOS PAC ID | 8123443108 |
|---|---|
| Medicare Enrollment ID | O20200807001543 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447877386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kinsey A Shultz Piatz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770598427 PECOS PAC ID: 9638178916 Enrollment ID: I20180503001747 |
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