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AVERA QUEEN OF PEACE

Prosthetic/Orthotic Supplier

An organization which supplies or vends orthopedic appliances or apparatuses and artificial body parts used to support, align, prevent, or correct deformities or to replace or improve function of body parts.

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Contact Information

AVERA QUEEN OF PEACE
625 N FOSTER ST
SUITE 200
MITCHELL, SD  57301-2969
 Phone: 605-996-3963
 Fax: 605-996-0718
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Prosthetic/Orthotic Supplier

 335E00000X 51 Medical Supply Company with Orthotist
Indicates primary specialty

NPI Profile & details for AVERA QUEEN OF PEACE

NPI Number 1710184569
LBN Legal business name AVERA QUEEN OF PEACE
Authorized official DOUGLAS EKEREN - (PRESIDENT/CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 06/27/2007
Last updated 08/20/2020 - About 6 years ago
Identifiers
SD License # 100-1023
SD Medicaid 0100130
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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