# AVERA ST LUKES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avera St Lukes Physician Specialist Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174548937
- **Authorized official:** RON JACOBSON (PRESIDENT)
- **Authorized official phone:** (605) 622-5502

## Contact information

- **Practice address:** 1400 10TH AVE W, MOBRIDGE, SD 57601-1246
- **Practice address phone:** (605) 845-7292
- **Practice address fax:** (605) 845-7812
- **Mailing address:** 1400 10TH AVE W, MOBRIDGE, SD 57601-1246
- **Mailing address phone:** (605) 845-7292
- **Mailing address fax:** (605) 845-7812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 246R00000X | Pathology Technician | — | NULL | Yes |
| 246R00000X | Pathology Technician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 09/11/2025