Healthcare Provider Details

I. General information

NPI: 1972082683
Provider Name (Legal Business Name): AVERA ST. MARY'S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E WELLS AVE
PIERRE SD
57501-3962
US

IV. Provider business mailing address

PO BOX 5045 CBO PALM PLACE PROVENRLMT
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-3100
  • Fax:
Mailing address:
  • Phone: 650-322-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SHANTEL KREBS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 605-351-5916