Provider Demographics
NPI:1538941794
Name:BLACK HILLS MOBILE HEALTHCARE LLC
Entity type:Organization
Organization Name:BLACK HILLS MOBILE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:605-770-8320
Mailing Address - Street 1:PO BOX 2480
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-2480
Mailing Address - Country:US
Mailing Address - Phone:605-770-8320
Mailing Address - Fax:
Practice Address - Street 1:1315 HAINES AVE STE D
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2453
Practice Address - Country:US
Practice Address - Phone:605-770-8320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty