RUSHMORE AMBULATORY SURGERY CENTER NPI 1013968718

NPI Information

NPI: 1013968718
Provider Name: RUSHMORE AMBULATORY SURGERY CENTER
Classification: Clinic/Center - 261QA1903X
Specialization: Ambulatory Surgical
Entity Type: Organization
Doing Business As: BLACK HILLS PEDIATRIC DENTISTRY SURGERY CENTER
Address: 620 SHERIDAN LAKE RD
SUITE 104
RAPID CITY, SD
ZIP 57702
Phone: (605) 341-1314

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NPI Details

RUSHMORE AMBULATORY SURGERY CENTER is an ambulatory surgical clinic center in Rapid City, SD. RUSHMORE AMBULATORY SURGERY CENTER NPI is 1013968718. The provider is registered as an organization entity type.
The provider Is Doing Business As Black Hills Pediatric Dentistry Surgery Center.

The provider's business location address is:

620 SHERIDAN LAKE RD
SUITE 104
RAPID CITY, SD
ZIP 57702-406
Phone: (605) 341-1314
Fax: (605) 341-5757

The provider's authorized official is Kelli J Jobman .
The authorized official title is Ceo and has the following contact phone number (605) 718-9224.

The enumeration date for this NPI number is 5/15/2006 and was last updated on 8/9/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5490450	MEDICAID	SOUTH DAKOTA
2	81022	OTHER	SOUTH DAKOTA	WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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