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Organization
AVERA ST LUKES
Active
Organization
AVERA ST LUKES
Active
Other names
Avera St Lukes Physician Specialist Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RON JACOBSON (PRESIDENT)
(605) 622-5502
Entity
Organization
Contact information
Practice address
1400 10TH AVE W, MOBRIDGE, SD 57601-1246
(605) 845-7292
(605) 845-7812
Mailing address
1400 10TH AVE W, MOBRIDGE, SD 57601-1246
(605) 845-7292
(605) 845-7812
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
246R00000X
Pathology Technician
Primary
—
NULL
246R00000X
Pathology Technician
Primary
—
—
Other
Enumeration date
07/13/2006
Last updated
09/11/2025
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