Organization
AVERA ST. LUKE'S
Active
Other names
Avera Medical Group Pediatrics Aberdeen
Organization subpart
No
Provider details
NPI number
Authorized official
TODD FORKEL (PRESIDENT & CEO)
(605) 622-5125
Entity
Organization
Contact information
Practice address
201 S LLOYD ST, E205, ABERDEEN, SD 57401-4552
(605) 622-4050
(605) 622-4049
Mailing address
PO BOX 1460, ABERDEEN, SD 57402-1460
(605) 622-4050
(605) 622-4049
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
10525
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14000
—
ND
01
—
4993532
WELLMARK BC/BS OF SD
SD
01
—
9237225
DAKOTACARE
SD
Enumeration date
06/17/2006
Last updated
02/12/2014
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