AVERA ST LUKES


Address: 1400 10th Ave W, Mobridge, SD 57601-1246
Phone: 6058457292

AVERA ST LUKES (NPI# 1174548937) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1174548937
Entity Type Organization
Organization Name AVERA ST LUKES
Other Organization Name AVERA ST LUKES PHYSICIAN SPECIALIST CLINIC
Practice Address 1400 10th Ave W
Mobridge
SD 57601-1246
Practice Telephone 6058457292
Practice Fax Number 6058457812
Mailing Telephone 6058457292
Mailing Fax Number 6058457812
Enumeration Date 2006-07-13
Last Update Date 2020-08-22
Authorized Official Name RON JACOBSON (PRESIDENT)
Authorized Official Telephone 6056225502
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
X 2085R0202X Radiology
Specialization: Diagnostic Radiology
Allopathic & Osteopathic Physicians
X 246R00000X Technician, Pathology Technologists, Technicians & Other Technical Service Providers

Other Provider/Organization Names

Other Name Type Code
Avera St Lukes Physician Specialist Clinic Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1932203015 Avera St Lukes Internal Medicine 201 S Lloyd St Ste W240, Aberdeen, SD 57401-4530 2006-09-11
1386693430 Avera St Lukes Skilled Nursing Facility 1002 N Jay St, Aberdeen, SD 57401-2439 2006-05-08
1831504711 Avera St Lukes Clinic/Center 310 S Penn St, Ste 201, Aberdeen, SD 57401 2014-06-30
1780004713 Avera St Lukes Radiology 310 S Penn St, Suite 105, Aberdeen, SD 57401 2014-04-17
1386738102 Avera St Lukes Pharmacy 305 S State St, Aberdeen, SD 57401-4527 2006-10-03
1912011867 Avera St Lukes Prosthetic/Orthotic Supplier 305 S State St, Aberdeen, SD 57401-4527 2006-08-18
1760423057 Avera St Lukes Clinic/Center 240 Main St, Ellendale, ND 58436 2006-06-09
1013968940 Avera St Lukes Medicare Defined Swing Bed Unit 305 S State St, Aberdeen, SD 57401-4527 2006-05-15
1003867029 Avera St Lukes Psychiatric Hospital 305 S State St, Aberdeen, SD 57401-4527 2006-05-15
1649221664 Avera St Lukes Clinic/Center 305 S State St, Aberdeen, SD 57401-4527 2006-05-15

Office Location

Street Address 1400 10TH AVE W
City MOBRIDGE
State SD
Zip Code 57601-1246

Providers in the same location

NPI Name Taxonomy Address Enumeration
1902248099 John Charles Olson Optometrist 1400 10th Ave W, Mobridge, SD 57601-1246 2013-07-18
1639373756 Avera St. Luke's Family Medicine 1400 10th Ave W, Mobridge, SD 57601-1246 2007-06-13

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1881761096 Alfred T Smith Counselor 1245 Hwy 1806th, Mobridge, SD 57601 2006-11-30
1912078429 Carmen J. Cutt Counselor 12451 Highway 1806, Mobridge, SD 57601 2006-11-13
1629090162 Craig Dockter Optometrist 1315 10th Ave, Mobridge, SD 57601 2006-07-24
1437786373 Courtney M Nicholson Counselor 12451 Hwy 1806, Mobridge, SD 57601 2020-03-23
1922634062 Mary Lerae Herman Registered Nurse 12451 Hwy 1806, Mobridge, SD 57601 2020-03-20
1063870194 Karen Fryhling Nurse Practitioner 1309 10th Ave W, Mobridge, SD 57601 2016-02-03
1508271115 Matthew Jacob Schaffer Family Medicine 1309 10th Ave W, Mobridge, SD 57601 2014-06-23
1871807206 Shadow Anesthesia Services, LLC Clinic/Center 1401 10th Ave W, Mobridge, SD 57601 2010-07-27
1902051162 Celeste Anne Karzon Specialist 12451 Hwy 1806, Mobridge, SD 57601 2008-12-01
1598975997 Roxann Dakota Spottedeagle Counselor 12451 Hwy 1806, Mobridge, SD 57601 2007-05-23
Find all providers in zip 57601

Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1720421381 Jamie Catherine Williams Radiology 1309 W 17th St Ste G01, Sioux Falls, SD 57104-4663 2013-04-14
1518284223 Neil Kumar Radiology 2929 5th St Ste 230, Rapid City, SD 57701-7338 2010-04-21
1952535536 Sacred Heart Health Services Radiology 501 Summit St Ste 8, Yankton, SD 57078-3855 2009-05-11
1841430162 Martin Frank Petereit Radiology 1600 E. Cedar Lane, Retired Radiologist, Sioux Falls, SD 57103 2009-02-26
1558510586 Diagnostic Radiology Services, Prof, LLC Radiology 2212 Valley Rd, Yankton, SD 57078-1895 2008-09-15
1629267224 Clark L Carrol Radiology Box 1020665, Sioux Falls, SD 57186-0001 2007-10-18
1861685166 Sanford Clinic Radiology 891 14th Ave Ne, Watertown, SD 57201 2007-08-21
1194865394 Midwest Regional Imaging Services LLC Radiology 6001 S Sharon, Suite 2, Sioux Falls, SD 57108 2007-02-07
1114085693 Tamara Sue Wheeler Radiology 2200 N Kimball # 700, Mitchell, SD 57301 2006-12-05
1780751099 Kelly Don Smith Radiology 2200 N Kimball #700, Mitchell, SD 57301 2006-11-29
Find all providers with the same taxonomy

Competitor

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City MOBRIDGE
Zip Code 57601

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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