Healthcare Provider Details

I. General information

NPI: 1841505807
Provider Name (Legal Business Name): AVERA ST MARYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN
PIERRE SD
57501-3391
US

IV. Provider business mailing address

100 MAC LN
PIERRE SD
57501-3391
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5901
  • Fax: 605-945-3177
Mailing address:
  • Phone: 605-224-5901
  • Fax: 605-945-3177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number10556
License Number StateSD

VIII. Authorized Official

Name: MIKEL HOLLAND
Title or Position: CEO/PRESIDENT
Credential:
Phone: 605-224-3144