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Contact Information

KERRY A BLACKHAM, DO
503 W PINE ST
PHILIP, SD57567-0550
 Phone: 605-859-2566
 Fax: 605-859-2948
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for KERRY A BLACKHAM · (Male)

NPI Number 1922014273
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/31/2006
Last updated 01/09/2019 - About 7 years ago
Sole proprietor 1 Yes
Identifiers
  • SD License # 9452
  • SD Medicaid S110986
Hospital affiliation(s)
  • RAPID CITY REGIONAL HOSPITAL - (Acute Care)
    353 FAIRMONT BLVD POST OFFICE BOX 6000
    RAPID CITY, SD 57701
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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