Healthcare Provider Details

I. General information

NPI: 1831504711
Provider Name (Legal Business Name): AVERA ST LUKES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S PENN ST STE 201
ABERDEEN SD
57401-4553
US

IV. Provider business mailing address

PO BOX 860674
MINNEAPOLIS MN
55486-0001
US

V. Phone/Fax

Practice location:
  • Phone: 605-229-1367
  • Fax: 605-229-1002
Mailing address:
  • Phone: 605-229-1367
  • Fax: 605-229-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10525
License Number StateSD

VIII. Authorized Official

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