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NPI Code Detail

MEDICARE: AVERA QUEEN OF PEACE

MEDICARE: AVERA QUEEN OF PEACE
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
1207P00000XEmergency Medicine Physician
2207Q00000XFamily Medicine Physician
3367500000XCertified Registered Nurse Anesthetist
4282NR1301XRural Acute Care Hospital10552SD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CR0890OTHERSDRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154324507
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVERA QUEEN OF PEACE
Provider Business Mailing Address
First Line : 525 N FOSTER ST
Second Line :
City : MITCHELL
State : SD
Zip : 57301-2966
Country : US
Telephone Number : 605-995-2000
Fax Number : 605-995-2441
Provider Business Practice Location Address
First Line : 525 N FOSTER ST
Second Line :
City : MITCHELL
State : SD
Zip : 57301-2966
Country : US
Telephone Number : 605-995-2000
Fax Number : 605-995-2441
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DOUGLAS EKEREN
Credential :
Telephone Number : 605-668-8322
Provider Enumeration Date : 05/31/2005
Last Update Date : 08/20/2020

Similar Medicare Providers

1780689489 — AVERA QUEEN OF PEACE
Practice Location Address:
525 N FOSTER ST
MITCHELL, SD
57301-2966
Practice Phone: 605-995-2000
Practice Fax: 605-995-2441
1851396550 — AVERA QUEEN OF PEACE
Practice Location Address:
525 N FOSTER ST
MITCHELL, SD
57301-2966
Practice Phone: 605-995-2460
Practice Fax: 605-995-5672
1740286285 — DR. KIM LORENZEN M.D.
Practice Location Address:
525 N FOSTER ST
MITCHELL, SD
57301-2966
Practice Phone: 605-995-2343
Practice Fax:
1215927355 — DR. MARK THOMAS DOOHEN M.D.
Practice Location Address:
525 N FOSTER ST
MITCHELL, SD
57301-2966
Practice Phone: 605-995-2276
Practice Fax:
1124005269 — CAMPUS PHARMACY
Practice Location Address:
525 N FOSTER ST
MITCHELL, SD
57301-2966
Practice Phone: 605-995-5670
Practice Fax: 605-996-6805
1437139268 — MR. ED HIGGINS
Practice Location Address:
525 N FOSTER ST
MITCHELL, SD
57301-2966
Practice Phone: 605-995-2000
Practice Fax:

Directions to “AVERA QUEEN OF PEACE ” Practice Location

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