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Organization
AVERA ST MARYS
Active
Organization
AVERA ST MARYS
Active
Other names
Avera St Marys Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS JAMES WAGNER (CFO)
(605) 224-3127
Entity
Organization
Contact information
Practice address
801 E SIOUX AVE, PIERRE, SD 57501
(605) 224-3100
(605) 224-8339
Mailing address
801 E SIOUX AVE, PIERRE, SD 57501
(605) 224-3100
(605) 224-8339
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
437046
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0170030
—
SD
01
—
87046
BLUE CROSS PROVIDER #
SD
Enumeration date
08/04/2006
Last updated
07/07/2014
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