Spearfish Healthcare, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10686 Issued in SD

Legal business name

SPEARFISH HEALTHCARE, LLC

Practice address

1020 North 10TH Street
Spearfish, SD 57783-2203

Phone

(605) 642-2716

Fax

(605) 722-0757

NPI assigned

Jul 6, 2006

Organization subpart

Yes

Parent organization

MISSION HEALTHCARE, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas E. Boerboom

Title

Chief Operating Officer

Phone

(952) 873-7907

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• David M. Dorsett Healthcare Center Doing business as

Part of

Welcov Healthcare LLC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1174555858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 NORTH 10TH STREET",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832203",
            "telephone_number": "605-642-2716",
            "fax_number": "605-722-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 NORTH 10TH STREET",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832203",
            "telephone_number": "605-642-2716",
            "fax_number": "605-722-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEARFISH HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSION HEALTHCARE, LLC",
        "enumeration_date": "2006-07-06",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "BOERBOOM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "952-873-7907",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "85043",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150412",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David M. Dorsett Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Spearfish Collaborative Care LLC
• Spearfish Emergency Ambulance Service
• Spearfish Eye Care Center
• Spearfish Family Chiropractic, PLLC
• Spearfish Health Center, PC
• Spearfish Nursing and Rehab Center LLC
• Spearfish Physical Therapy LLC
• Spearfish Regional Hospital
• Spearfish School District
• Spearfish Vision Works, P.C.

• All providers in Spearfish, SD
• Skilled Nursing Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.