Organization
AVERA QUEEN OF PEACE
Active
Parent organization
AVERA QUEEN OF PEACE
Other names
Avera Brady DME Supplier
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVERA QUEEN OF PEACE
Authorized official
DOUGLAS EKEREN (PRESIDENT/CEO)
(605) 668-8322
Entity
Organization
Contact information
Practice address
500 S OHLMAN ST, MITCHELL, SD 57301-3109
(605) 996-7701
Mailing address
525 N FOSTER ST, MITCHELL, SD 57301-2966
(605) 995-2000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
10652
SD
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
N/A
SD
Other
Enumeration date
06/17/2005
Last updated
08/20/2020
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