| Southern Hills Family Medicine, Prof Llc | |
|
1369 Montgomery St Custer SD 57730-8246 | |
| (605) 673-3900 | |
| Not Available |
| Full Name | Southern Hills Family Medicine, Prof Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1369 Montgomery St, Custer, South Dakota |
| Authorized Official Name and Position | Brandyn A Tarap (SOLE MEMBER) |
| Authorized Official Contact | 6056733900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Hills Family Medicine, Prof Llc 1369 Montgomery St Custer SD 57730-8246 Ph: (605) 673-3900 | Southern Hills Family Medicine, Prof Llc 1369 Montgomery St Custer SD 57730-8246 Ph: (605) 673-3900 |
| NPI Number | 1457013963 |
|---|---|
| Provider Enumeration Date | 10/12/2021 |
| Last Update Date | 09/07/2023 |
| Medicare PECOS PAC ID | 8224427968 |
|---|---|
| Medicare Enrollment ID | O20211117003207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457013963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brenda Vandewater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669847067 PECOS PAC ID: 7315236775 Enrollment ID: I20160525001313 |
| Provider Name | Brandyn Tarap |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619316585 PECOS PAC ID: 2264720598 Enrollment ID: I20161019001100 |
Custer Regional Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1041 Montgomery St, Custer, SD 57730 Phone: 605-673-4150 | |
Regional Health Physicians Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1041 Montgomery St, Custer, SD 57730 Phone: 605-673-4150 | |
Custer Regional Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1041 Montgomery St, Custer, SD 57730 Phone: 605-673-4150 |