Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oxygen Equipment & Supplies |
332BX2000X | B1 | Oxygen supplier | |
Institutional Pharmacy |
3336I0012X | 58 | Medical Supply Company with Pharmacist | |
Prosthetic/Orthotic Supplier |
335E00000X | 51 | Medical Supply Company with Orthotist |
| NPI Number | 1912011867 |
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| LBN Legal business name | AVERA ST LUKES | ||||||||
| Authorized official | RONALD JACOBSON - (CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | Yes | ||||||||
| Enumeration date | 08/18/2006 | ||||||||
| Last updated | 10/22/2007 - About 19 years ago | ||||||||
| Identifiers |
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AVERA ST LUKES
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