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Organization
AVERA ST. LUKE'S
Active
Organization
AVERA ST. LUKE'S
Active
Other names
Avera Medical Group Orthopedics Aberdeen
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON L JACOBSON (CEO AND PRESIDENT)
(605) 622-5230
Entity
Organization
Contact information
Practice address
815 1ST AVE SE, ABERDEEN, SD 57401-4602
(605) 622-2570
(605) 622-2571
Mailing address
PO BOX 1460, ABERDEEN, SD 57402-1460
(605) 622-2857
(605) 622-2859
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
10525
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14555
—
ND
01
—
9251368
DAKOTACARE
SD
Enumeration date
10/02/2007
Last updated
06/15/2011
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