Advanced ENT and Allergy Center of the Black Hills, Prof LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

ADVANCED ENT AND ALLERGY CENTER OF THE BLACK HILLS, PROF LLC

Doing business as

Advanced ENT and Allergy Center of the Black Hills, Prof LLC

Practice address

4940 5TH St Ste 2B
Rapid City, SD 57701-6026

Phone

(605) 716-6390

NPI assigned

Oct 20, 2020

Last updated

Feb 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jay Warren White, MD

Title

Owner

Phone

(605) 716-6390

Specialties & licenses 1

Addresses

Other names 1

• Advanced ENT and Allergy Center of the Black Hills, Prof LLC Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shannon T White, CRNA

  • Certified Registered Nurse Anesthetist
  • Rapid City, SD
  • NPI 1396791869
  NPD (past)

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1346849478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4940 5TH ST STE 2B",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016026",
            "telephone_number": "605-716-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 5TH ST STE 2B",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016026",
            "telephone_number": "605-716-6390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED ENT AND ALLERGY CENTER OF THE BLACK HILLS, PROF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-716-6390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "notavailable",
            "affiliation": "N",
            "endpointDescription": "notavailable",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "not available",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "not available",
            "address_1": "4940 5th St Ste 2B",
            "city": "Rapid City",
            "state": "SD",
            "country_code": "US",
            "postal_code": "577016026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Advanced ENT and Allergy Center of the Black Hills, Prof LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced ENT and Allergy Center of the Black Hills, Prof LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.