Avera Medical Group Orthopedics & Sports Medicine

LBN: Avera Queen Of Peace
Avera Medical Group Orthopedics & Sports Medicine is an health care organization with primary practice located at 625 N Foster St Suite 200, Mitchell SD 57301-2969. The organization recently has only one registered license in Suppliers / Prosthetic/Orthotic Supplier, which is considered as the primary health care specialty. Avera Queen Of Peace can be contacted via phone (605) 996-3963, or through Ekeren, Douglas via phone (605) 668-8322.

Contact Information

Primary practice address
625 N Foster St Suite 200 Mitchell SD 57301-2969
Phone: (605) 996-3963
Fax: (605) 996-0718
Website:
Map and Directions
Authorized official contact:
Name: Ekeren, Douglas
Phone: (605) 668-8322

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Prosthetic/Orthotic Supplier 335E00000X 100-1023 South Dakota

Profile Details

NPI number 1710184569
LBN Legal business name Avera Queen Of Peace
DBA Doing business as Avera Medical Group Orthopedics & Sports Medicine
Authorized official Ekeren, Douglas
Entity Organization
Organization subpart 1 No
Enumeration date Jun 27th, 2007
Last updated Aug 20th, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710184569 NPPES
South Dakota MEDICAID 0100130

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