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General NPI Number Information
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NPI Number | 1073305496
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Entity Type | Organization
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Legal Business Name | AVERA ST MARYS
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 801 E SIOUX AVE
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City | PIERRE
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State | SD
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Zip | 57501-3323
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Country | US
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Telephone | 605-224-3100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860674
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SHANTEL KREBS
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Credential |
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Telephone | 605-351-5916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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