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AVERA QUEEN OF PEACE NPI 1326283797


NPI Information

NPI: 1326283797
Provider Name: AVERA QUEEN OF PEACE

Doing Business As: AVERA MEDICAL GROUP OBSTETRICS AND GYNECOLOGY

Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization
Address:
1900 GRASSLAND DR
MITCHELL, SD
ZIP 57301
Phone: (605) 995-6350
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AVERA QUEEN OF PEACE is an obstetrics gynecology in Mitchell, SD. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. AVERA QUEEN OF PEACE NPI is 1326283797. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Avera Medical Group Obstetrics And Gynecology.

The provider's business location address is:

1900 GRASSLAND DR
MITCHELL, SD
ZIP 57301-335
Phone: (605) 995-6350
Fax: (605) 995-6353

The provider's authorized official is Douglas Ekeren .
The authorized official title is President/ceo and has the following contact phone number (605) 668-8322.

The enumeration date for this NPI number is 12/12/2008 and was last updated on 10/27/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1S1639OTHERSOUTH DAKOTAMEDICARE PTAN
22127532OTHERTEXASTEXAS MEDICAID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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