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).
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 |
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 Name | Type Code |
---|---|
Avera St Lukes Physician Specialist Clinic | Doing Business As Name - Organization |
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 |
Street Address |
1400 10TH AVE W |
City | MOBRIDGE |
State | SD |
Zip Code | 57601-1246 |
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 |
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 Code | 2085R0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Radiology |
Specialization | Diagnostic Radiology |
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. |
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 |
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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.