Healthcare Provider Details

I. General information

NPI: 1376831933
Provider Name (Legal Business Name): AVERA ST. LUKE'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST AVE SE STE 100
ABERDEEN SD
57401-4604
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-1420
  • Fax: 605-225-3307
Mailing address:
  • Phone: 605-322-4933
  • Fax: 605-504-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10525
License Number StateSD

VIII. Authorized Official

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