Healthcare Provider Details

I. General information

NPI: 1083051817
Provider Name (Legal Business Name): AVERA ST. LUKE'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 8TH AVE NW STE C
ABERDEEN SD
57401-1865
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-622-5123
  • Fax: 605-622-5906
Mailing address:
  • Phone: 605-322-4933
  • Fax: 605-504-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J BJERKNES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 605-622-5125