Organization
AVERA ST. LUKE'S
Active
Other names
Aberdeen Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
RON L JACOBSON (PRESIDENT & CEO)
(605) 622-5125
Entity
Organization
Contact information
Practice address
201 S LLOYD ST, SUITE W270, ABERDEEN, SD 57401-4552
(605) 225-4070
(605) 725-2416
Mailing address
PO BOX 1460, ABERDEEN, SD 57402-1460
(605) 225-4070
(605) 725-2416
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10525
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14389
—
ND
01
—
9251433
DAKOTACARE
SD
Enumeration date
06/27/2007
Last updated
06/30/2011
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