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1740109677 NPI number — AVERA ST LUKE'S

NPI Number: 1740109677
Health Care Provider/Practitioner: AVERA ST LUKE'S

Information about “1740109677” NPI (AVERA ST LUKE'S) exists in 1740109677 in HTML format HTML  |  1740109677 in plain Text format TXT  |  1740109677 in PDF (Portable Document Format) PDF  |  1740109677 in an XML format XML  formats.

NPI Number : 1740109677 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740109677",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "AVERA HEALTH",
    "ParentOrgTIN": null,
    "OrgName": "AVERA ST LUKE'S",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 360452",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PITTSBURGH",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "15250-6452",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-622-2895",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "310 S PENN ST STE 203",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ABERDEEN",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57401-4553",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-622-2895",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/14/2026",
    "LastUpdateDate": "07/14/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BJERKNES",
    "AuthorizedOfficialFirstName": "DANIEL",
    "AuthorizedOfficialMiddleName": "J",
    "AuthorizedOfficialTitle": "REGIONAL PRESIDENT & CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "605-622-5230",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2085R0204X",
        "TaxonomyName": "Vascular & Interventional Radiology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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