AVERA QUEEN OF PEACE (NPI# 1568986040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1568986040 |
Entity Type | Organization |
Organization Name | AVERA QUEEN OF PEACE |
Other Organization Name | AVERA MEDICAL GROUP ONCOLOGY & HEMATOLOGY MITCHELL |
Practice Address |
605 N Foster St Ste 100 Mitchell SD 57301-2902 |
Mailing Address |
Po Box 432 Mitchell SD 57301-0432 |
Practice Telephone | (605) 995-5756 |
Practice Fax Number | 6059955750 |
Mailing Telephone | 6059956337 |
Mailing Fax Number | 6059955779 |
Enumeration Date | 2017-07-27 |
Last Update Date | 2020-08-20 |
Authorized Official Name | DOUGLAS EKEREN (PRESIDENT/CEO) |
Authorized Official Telephone | 6056688322 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SD | MEDICARE | S1639 | 01 |
Other Name | Type Code |
---|---|
Avera Medical Group Oncology & Hematology Mitchell | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689051682 | Avera Queen of Peace | Clinic/Center | 409 S Ohlman St, Mitchell, SD 57301-3106 | 2015-04-29 |
1649577297 | Avera Queen of Peace | Clinic/Center | 1900 Grassland Dr., Mitchell, SD 57301-6205 | 2011-02-17 |
1053557967 | Avera Queen of Peace | Physician Assistant | 115 Second St Se, De Smet, SD 57231-0463 | 2008-12-23 |
1699972422 | Avera Queen of Peace | Specialist | 625 N Foster St Ste 200, Mitchell, SD 57301-2968 | 2007-06-27 |
1992712921 | Avera Queen of Peace | Pharmacy | 609 1st St Ne, Wessington Springs, SD 57382-2136 | 2006-08-02 |
1932105046 | Avera Queen of Peace | Clinic/Center | 265 Main Street, Corsica, SD 57328 | 2005-06-23 |
1326043092 | Avera Queen of Peace | Clinic/Center | 213 South Main, Howard, SD 57349 | 2005-06-17 |
1316942204 | Avera Queen of Peace | Clinic/Center | 604 1st St Ne, Wessington Springs, SD 57382-2134 | 2005-06-16 |
1639174568 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2005-06-16 |
1144225129 | Avera Queen of Peace | Skilled Nursing Facility | 500 S Ohlman St, Mitchell, SD 57301-3109 | 2005-06-16 |
Street Address |
605 N FOSTER ST STE 100 |
City | MITCHELL |
State | SD |
Zip Code | 57301-2902 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932721388 | Dakota Counseling Institute | Social Worker | 910 W Havens, Mitchell, SD 57301 | 2020-05-08 |
1215588512 | Carolyn Marie Klinkhammer | Registered Nurse | 525 North Foster - Avera Queen of Peace Hospital, Mitchell, SD 57301 | 2019-09-27 |
1720596893 | Brian Bannwarth | Pharmacist | 25147 Campground Road, Mitchell, SD 57301 | 2018-01-11 |
1336664135 | Haley Long | Speech-Language Pathologist | 200 East Havens, Mitchell, SD 57301 | 2017-08-14 |
1770004996 | Edgewood Mitchell LLC | Assisted Living Facility | 501 East Spruce Street, Mitchell, SD 57301 | 2017-06-28 |
1467831685 | Amanda Louise Johnson | Physical Therapist | 910 S Edgerton, Mitchell, SD 57301 | 2015-05-20 |
1922432830 | Melissa Jill Maier | Dentist | 240 E 23 Ave, Mitchell, SD 57301 | 2013-08-27 |
1356626972 | Lewis Family Drug, LLC | Pharmacy | 1507 N Main St, Mitchell, SD 57301 | 2011-10-14 |
1184945958 | Kimberly L Lienemann | Counselor | 403 N Lawler St, Mitchell, SD 57301 | 2010-06-16 |
1134365554 | Gronsten-maier Dental Prof. LLC | Dentist | 240 E. 23rd Avenue, Mitchell, SD 57301 | 2009-01-07 |
Find all providers in zip 57301 |
Taxonomy Code | 207RH0003X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Hematology & Oncology |
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336483551 | Avera St. Luke's | Internal Medicine | 310 S Penn St Ste 106, Aberdeen, SD 57401-4553 | 2012-11-15 |
1184935652 | Houman Nourkeyhani | Internal Medicine | 1000 E 23rd St Ste 230, Sioux Falls, SD 57105-2122 | 2010-06-29 |
1518148535 | Richard J Conklin, Md | Internal Medicine | 620 3rd Ave Se, Aberdeen, SD 57401-4507 | 2007-11-19 |
1124017256 | Michael Stephen Mchale | Internal Medicine | 1000 E. 23rd St., Ste. 230, Sioux Falls, SD 57105-2122 | 2005-10-20 |
1275528382 | Thomas B Tan | Internal Medicine | Rapid City Regional Hospital, 353 Fairmont Blvd., Rapid City, SD 57701 | 2005-09-14 |
1437155140 | Miroslaw A Mazurczak | Internal Medicine | 1309 W 17th St, Ste 101, Sioux Falls, SD 57104-8805 | 2005-06-27 |
1851394662 | Richard J Conklin | Internal Medicine | 310 S Penn St, Suite 105, Aberdeen, SD 57401-4553 | 2005-05-24 |
1457831497 | Conklin Clinics, Prof LLC | Internal Medicine | 1409 6th Ave Se Ste 5, Aberdeen, SD 57401-4950 | 2018-08-20 |
1164780201 | Avera Mckennan | Internal Medicine | 3720 W 69th St, Sioux Falls, SD 57108-8192 | 2012-04-26 |
1063787083 | Rapid City Regional Hospital Inc | Internal Medicine | 353 Fairmont Blvd, Rapid City, SD 57701-7375 | 2012-03-09 |
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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.