AVERA QUEEN OF PEACE NPI 1952635492

NPI Information

NPI: 1952635492
Provider Name: AVERA QUEEN OF PEACE

Doing Business As: AVERA MEDICAL GROUP CORSICA

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
265 MAIN STREET
CORSICA, SD
ZIP 57328
Phone: (605) 946-5411
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AVERA QUEEN OF PEACE is a rural health clinic center in Corsica, SD. AVERA QUEEN OF PEACE NPI is 1952635492. The provider is registered as an organization entity type.
The provider Is Doing Business As Avera Medical Group Corsica.

The provider's business location address is:

265 MAIN STREET
CORSICA, SD
ZIP 57328
Phone: (605) 946-5411
Fax: (605) 946-5206

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 10/1/2009 and was last updated on 8/20/2020.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health	NA	SOUTH DAKOTA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00-00435	OTHER	SOUTH DAKOTA	MEDICA
2	5306743	MEDICAID	SOUTH DAKOTA
3	4991000	OTHER	SOUTH DAKOTA	WELLMARK

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: 5/5/2024

NPI Synchronization or Removal

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