Organization
AVERA QUEEN OF PEACE
Active
Other names
Avera Medical Group Orthopedics & Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS EKEREN (PRESIDENT/CEO)
(605) 668-8322
Entity
Organization
Contact information
Practice address
625 N FOSTER ST, SUITE 200, MITCHELL, SD 57301-2969
(605) 996-3963
(605) 996-0718
Mailing address
625 N FOSTER ST, SUITE 200, MITCHELL, SD 57301-2969
(605) 995-2000
(605) 995-2441
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
100-1023
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100130
—
SD
Enumeration date
06/27/2007
Last updated
08/20/2020
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