{
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"EIN": null,
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"OrgName": "AVERA ST. LUKE'S",
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 1460",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ABERDEEN",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57402-1460",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-622-2607",
"MailingAddressFaxNumber": "605-622-2608",
"FirstLinePracticeLocationAddress": "310 S PENN ST",
"SecondLinePracticeLocationAddress": "SUITE 203",
"PracticeLocationAddressCityName": "ABERDEEN",
"PracticeLocationAddressStateName": "SD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "605-622-2607",
"PracticeLocationAddressFaxNumber": "602-622-2608",
"EnumerationDate": "07/28/2009",
"LastUpdateDate": "08/16/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STREIER",
"AuthorizedOfficialFirstName": "DEBBIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VICE PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "605-622-2807",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207T00000X",
"TaxonomyName": "Neurological Surgery Physician",
"LicenseNumber": "10525",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}