MEDICARE: AVERA HOME MEDICAL EQUIPMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	14003EST001	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144396102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA HOME MEDICAL EQUIPMENT, LLC

Provider Business Mailing Address
First Line	:	800 E 21ST ST
Second Line	:	PO BOX 5045
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1016
Country	:	US
Telephone Number	:	605-322-1872
Fax Number	:	605-322-1892

Provider Business Practice Location Address
First Line	:	1508 4TH ST NE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-6824
Country	:	US
Telephone Number	:	605-882-3511
Fax Number	:	605-882-3062

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	SANDRA D DIELEMAN
Credential	:
Telephone Number	:	605-322-1872

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/21/2022

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