AVERA ST. LUKE'S (NPI# 1619273927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619273927 |
| Entity Type | Organization |
| Organization Name | AVERA ST. LUKE'S |
| Other Organization Name | COSMETICS AND PLASTIC SURGERY |
| Practice Address |
4141 31st Ave S Ste 105 Fargo ND 58104-8778 |
| Mailing Address |
Po Box 1460 Aberdeen SD 57402-1460 |
| Practice Telephone | 6057255030 |
| Practice Fax Number | 6057255028 |
| Mailing Telephone | 6057255030 |
| Mailing Fax Number | 6057255028 |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2011-06-30 |
| Authorized Official Name | RON L JACOBSON (CEO) |
| Authorized Official Telephone | 6056225125 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
10525 | SD | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Cosmetics and Plastic Surgery | Doing Business As Name - Organization |
| 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 |
| 1558624668 | Avera St. Luke's | Family Medicine | 501 Bloemendaal Drive, Ipswich, SD 57451 | 2012-06-22 |
| 1013143296 | Avera St. Luke's | Family Medicine | 105 S State St Ste 113, Aberdeen, SD 57401-4502 | 2009-06-02 |
| 1215100813 | Avera St. Luke's | Dietitian, Registered | 105 S State St Ste 201, Aberdeen, SD 57401-4502 | 2008-04-04 |
| 1154346625 | Avera St. Luke's | Family Medicine | 4401 Main St, Selby, SD 57472 | 2006-07-13 |
| 1124459391 | Avera St. Luke's | Orthopaedic Surgery | 701 8th Ave Nw, Aberdeen, SD 57401 | 2013-12-12 |
| 1982030177 | Avera St. Luke's | Physician Assistant | 815 1st Ave Se, Aberdeen, SD 57401-4602 | 2013-09-19 |
| 1083051817 | Avera St. Luke's | Anesthesiology | 815 1st Ave Se, Aberdeen, SD 57401 | 2013-06-03 |
| 1912265489 | Avera St. Luke's | Internal Medicine | 310 S Penn St, Ste 203, Aberdeen, SD 57401 | 2012-05-02 |
| 1891073003 | Avera St. Luke's | Anesthesiology | 305 S State St, Aberdeen, SD 57401 | 2011-07-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AVERA ST LUKE'S HOSPITAL | 305 S State, Aberdeen, SD 57401-4527 |
| Street Address |
4141 31ST AVE S STE 105 |
| City | FARGO |
| State | ND |
| Zip Code | 58104-8778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837347 | Pinnacle Therapy & Wellness, Pllc | Physical Therapist | 4500 36th Ave S Suite 100, Fargo, ND 58104 | 2020-07-02 |
| 1619509858 | Patricia Helen Bathie | Counselor | 4243 Auburn Ave., Fargo, ND 58104 | 2020-02-05 |
| 1346892866 | Elizabeth Olis | Registered Nurse | 2633 55th St. S, Apartment 202, Fargo, ND 58104 | 2019-07-15 |
| 1780247023 | Keith Kirimi Ndege | Physical Therapy Assistant | 5225 23rd Ave South, Fargo, ND 58104 | 2019-04-22 |
| 1346728557 | Ms4 Pllc | Pharmacy | 4476 31st Avenue South, Suite #105, Fargo, ND 58104 | 2018-07-31 |
| 1891286977 | Jessica Rae Majidian | Dentist | 3030 49th St S, Fargo, ND 58104 | 2018-05-23 |
| 1821588500 | Alissa Nichole Larson | Pharmacist | 5675 26th Ave S St. 136a, Fargo, ND 58104 | 2018-05-17 |
| 1790297430 | Northern Lights Dental | Dentist | 4150 19th Ave S, Suite 301, Fargo, ND 58104 | 2017-11-03 |
| 1619406733 | Cobalt Rehabilitation Hospital Fargo LLC | Rehabilitation Hospital | 4671 38th Street S, Fargo, ND 58104 | 2017-06-12 |
| 1790210318 | Homefield Health, LLC | Clinic/Center | 4141 31st Ave S., Ste 102, Fargo, ND 58104 | 2017-04-21 |
| Find all providers in zip 58104 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669708129 | Diane R Schmidt-krings Md PC | Surgery | 3270 20th St S, Fargo, ND 58104-5917 | 2009-10-19 |
| 1255534871 | Ha Chim | Surgery | 2801 University Dr S, Fargo, ND 58103-6029 | 2007-06-10 |
| 1700907912 | Lamb Plastic Surgery Center PC | Surgery | 1507 South University Drive, Fargo, ND 58103 | 2007-04-03 |
| 1639259310 | Jeffrey R Keim | Surgery | 2801 University Dr S, Fargo, ND 58103-6029 | 2006-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184720948 | D'arcy Adaire Honeycutt | Surgery | 810 E Rosser Ave, Suite 303, Bismarck, ND 58501-4463 | 2006-09-16 |
Please comment or provide details below to improve the information on AVERA ST. LUKE'S.
| 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.