Organization
AVERA QUEEN OF PEACE
Active
Other names
Avera Medical Group Salem
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS EKEREN (PRESIDENT/CEO)
(605) 668-8322
Entity
Organization
Contact information
Practice address
741 S HILL ST, SALEM, SD 57058-8761
(605) 425-3038
(605) 425-3039
Mailing address
525 N FOSTER ST, MITCHELL, SD 57301-2966
(605) 995-2000
(605) 995-2441
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
NA
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-00592
MEDICA
SD
01
—
4991003
WELLMARK
SD
05
—
5307012
—
SD
01
—
CR0890
MEDICARE RAILROAD
SD
01
—
S1639
MEDICARE PART B
SD
Enumeration date
09/22/2009
Last updated
08/20/2020
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