Organization · NPI-2

Advanced Ent And Allergy Center Of The Black Hills, Prof LLC

Clinic/Center · Rapid City, SD

NPI number1346849478
StatusActive
Last updated in NPPESFeb 8, 2021

Details

NPI
1346849478
Entity type
Organization (NPI-2)
Legal business name
Advanced Ent And Allergy Center Of The Black Hills, Prof LLC
Organization subpart
No
Enumeration date
Oct 20, 2020
Certification date
Feb 8, 2021
Last updated
Feb 8, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Other names

  • Advanced Ent And Allergy Center Of The Black Hills, Prof LLC (Doing Business As)

Practice location

4940 5th St Ste 2b
Rapid City, SD 57701-6026

Phone 605-716-6390

Mailing address

4940 5th St Ste 2b
Rapid City, SD 57701-6026

Phone 605-716-6390

Authorized official

Jay Warren White
Owner
6057166390

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