Organization
AVERA QUEEN OF PEACE
Active
Other names
Avera Medical Group Howard
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS EKEREN (PRESIDENT/CEO)
(605) 668-8322
Entity
Organization
Contact information
Practice address
213 SOUTH MAIN, HOWARD, SD 55734
(605) 772-4426
(605) 772-4261
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-00593
MEDICA
SD
01
—
4999748
WELLMARK
SD
05
—
5300492
—
SD
01
—
CR0890
MEDICARE RAILROAD
SD
01
—
S1639
MEDICARE PART B
SD
Enumeration date
10/01/2009
Last updated
08/20/2020
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