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General NPI Number Information
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NPI Number | 1760423057
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Entity Type | Organization
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Legal Business Name | AVERA ST LUKES
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 240 MAIN ST
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City | ELLENDALE
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State | ND
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Zip | 58436
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Country | US
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Telephone | 701-349-3666
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Fax | 701-349-4945
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Provider Business Mailing Address
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Address Line | PO BOX 86370
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City | SIOUX FALLS
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State | SD
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Zip | 57118-6370
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Country | US
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Telephone | 605-322-4933
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Fax | 605-504-9489
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DANIEL J BJERKNES
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Credential |
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Telephone | 605-622-5125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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