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
1	363A00000X	Physician Assistant
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1881964484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA QUEEN OF PEACE

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-4933
Fax Number	:	605-504-9489

Provider Business Practice Location Address
First Line	:	801 3RD ST SW
Second Line	:
City	:	DE SMET
State	:	SD
Zip	:	57231-2224
Country	:	US
Telephone Number	:	605-854-3834
Fax Number	:	605-854-3878

Authorized Official
Title or Position	:	REGIONAL PRESIDENT/CEO
Name	:	HILARY R. ROCKWELL
Credential	:
Telephone Number	:	605-995-2200

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/22/2026

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Directions to “AVERA QUEEN OF PEACE ” Practice Location

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