Organization
AVERA ST. LUKE'S
Active
Other names
Mobridge Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON L JACOBSON (CEO)
(605) 622-5000
Entity
Organization
Contact information
Practice address
1400 10TH AVE W, MOBRIDGE, SD 57601-1246
(605) 845-7292
(605) 845-7812
Mailing address
PO BOX 710, MOBRIDGE, SD 57601-0710
(605) 845-7292
(605) 845-7812
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10525
SD
Other
Enumeration date
06/13/2007
Last updated
01/18/2008
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