Healthcare Provider Details

I. General information

NPI: 1003867029
Provider Name (Legal Business Name): AVERA ST LUKES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S STATE ST
ABERDEEN SD
57401-4527
US

IV. Provider business mailing address

305 S STATE ST
ABERDEEN SD
57401-4527
US

V. Phone/Fax

Practice location:
  • Phone: 605-622-5000
  • Fax: 605-622-5255
Mailing address:
  • Phone: 605-622-5000
  • Fax: 605-622-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number10525
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number10525
License Number StateSD

VIII. Authorized Official

Name: TESS MOELLER
Title or Position: EXEC VP
Credential:
Phone: 605-622-2807