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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
1275N00000XMedicare Defined Swing Bed Hospital Unit10552SD

General Provider Information

NPI Number : 1780689489
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 : 06/17/2005
Last Update Date : 08/20/2020

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Directions to “AVERA QUEEN OF PEACE ” Practice Location

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