AVERA QUEEN OF PEACE; NPI #1154324507

Contact Information

AVERA QUEEN OF PEACE

525 N FOSTER ST
MITCHELL, SD 57301-2966

Phone: 605-995-2000
Fax: 605-995-2441
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rural	282NR1301X
Emergency Medicine	207P00000X	93	Physician/Emergency Medicine
Family Medicine	207Q00000X	08	Physician/Family Practice
Nurse Anesthetist, Certified Registered	367500000X	43	Certified Registered Nurse Anesthetist (CRNA)

Indicates primary specialty

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NPI Profile & details for AVERA QUEEN OF PEACE

NPI Number 1154324507

LBN Legal business name AVERA QUEEN OF PEACE

Authorized official DOUGLAS EKEREN - (PRESIDENT/CEO)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/31/2005

Last updated 08/20/2020 - About 6 years ago

Identifiers

SD	License #	10552
SD	Medicaid	0100130
SD	Other	5500130	MEDICAID OUTPATIENT
SD	Other	CR0890	RR MEDICARE

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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