| Great Plains Geriatrics Llc | |
|
135 Ponderosa Ave Hill City SD 57745-6057 | |
| (612) 987-1090 | |
| Not Available |
| Full Name | Great Plains Geriatrics Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 135 Ponderosa Ave, Hill City, South Dakota |
| Authorized Official Name and Position | Ben Rodarte (CREDENTIALING/BILLING MANAGER) |
| Authorized Official Contact | 7202816172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Plains Geriatrics Llc 135 Ponderosa Ave Hill City SD 57745-6057 Ph: (612) 987-1090 | Great Plains Geriatrics Llc 135 Ponderosa Ave Hill City SD 57745-6057 Ph: (612) 987-1090 |
| NPI Number | 1710582903 |
|---|---|
| Provider Enumeration Date | 12/03/2020 |
| Last Update Date | 03/01/2023 |
| Medicare PECOS PAC ID | 4082027867 |
|---|---|
| Medicare Enrollment ID | O20210115002325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710582903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Curtis J Liedtke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770556599 PECOS PAC ID: 4688563521 Enrollment ID: I20040310001576 |
| Provider Name | Clemencia Rasquinha |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1023021409 PECOS PAC ID: 3476517988 Enrollment ID: I20210128002879 |
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