Organization
AVERA ST. LUKE'S
Active
Other names
Avera Medical Group Physical Medicine Aberdeen
Organization subpart
No
Provider details
NPI number
Authorized official
TESS MOELLER (VP)
(605) 622-2807
Entity
Organization
Contact information
Practice address
201 S LLOYD ST, SUITE E202, ABERDEEN, SD 57401-4552
(605) 622-2898
(605) 622-2897
Mailing address
PO BOX 1460, ABERDEEN, SD 57402-1460
(605) 622-2898
(605) 622-2897
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
10525
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13479
—
ND
01
—
9263552
DAKOTACARE
—
Enumeration date
06/16/2006
Last updated
07/15/2022
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