AVERA ST LUKES (NPI# 1780004713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1780004713 |
Entity Type | Organization |
Organization Name | AVERA ST LUKES |
Other Organization Name | AVERA MEDICAL GROUP RADIATION ONCOLOGY ABERDEEN |
Practice Address |
310 S Penn St Suite 105 Aberdeen SD 57401 |
Mailing Address |
Po Box 1460 Aberdeen SD 57402-1460 |
Practice Telephone | 6056228700 |
Practice Fax Number | 6056225042 |
Mailing Telephone | 6056222857 |
Mailing Fax Number | 6056222859 |
Enumeration Date | 2014-04-17 |
Last Update Date | 2020-04-02 |
Authorized Official Name | DEBBIE STREIER (VICE PRESIDENT) |
Authorized Official Telephone | 6056222807 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
SD | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SD | MEDICARE | S101808 | 01 |
Other Name | Type Code |
---|---|
Avera Medical Group Radiation Oncology Aberdeen | 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 |
1174548937 | Avera St Lukes | Radiology | 1400 10th Ave W, Mobridge, SD 57601-1246 | 2006-07-13 |
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 |
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 |
310 S PENN ST SUITE 105 |
City | ABERDEEN |
State | SD |
Zip Code | 57401 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1851394662 | Richard J Conklin | Internal Medicine | 310 S Penn St, Suite 105, Aberdeen, SD 57401-4553 | 2005-05-24 |
1407309057 | Chelsea R Westerman | Nurse Practitioner | 310 S Penn St, Suite 204, Aberdeen, SD 57401-4553 | 2016-08-01 |
1831504711 | Avera St Lukes | Clinic/Center | 310 S Penn St, Ste 201, Aberdeen, SD 57401 | 2014-06-30 |
1912265489 | Avera St. Luke's | Internal Medicine | 310 S Penn St, Ste 203, Aberdeen, SD 57401 | 2012-05-02 |
1720376825 | Christopher L Nelson | Nurse Practitioner | 310 S Penn St, Suite 105, Aberdeen, SD 57401-4553 | 2011-07-11 |
1669769998 | Shanna M. Anderson | Nurse Practitioner | 310 S Penn St, Suite 203, Aberdeen, SD 57401-4553 | 2011-07-07 |
1154641595 | Charles L. Pelton Jr. | Physician Assistant | 310 S Penn St, Suite 202, Aberdeen, SD 57401-4553 | 2010-06-08 |
1720317118 | Avera St. Luke's | Obstetrics & Gynecology | 310 S Penn St, Suite 204, Aberdeen, SD 57401 | 2009-12-14 |
1780815506 | Avera St. Luke's | Neurological Surgery | 310 S Penn St, Suite 203, Aberdeen, SD 57401 | 2009-07-28 |
1295990141 | Christopher M Larson | Surgery | 310 S Penn St, Suite 201, Aberdeen, SD 57401-4553 | 2008-07-21 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679002950 | Brenda Lee Pence | Registered Nurse | 305 S. State St., Aberdeen, SD 57401 | 2017-06-08 |
1104366475 | Jordan Shangreaux | Specialist/Technologist | 2200 S Roosevelt St, Aberdeen, SD 57401 | 2017-03-06 |
1205387545 | Midwest Medical Transport Company, LLC-aberdeen, Sd | Ambulance | 2919 Industrial Avenue, Aberdeen, SD 57401 | 2016-10-21 |
1356752471 | Cameron Eichler Enterprises | Hearing Aid Equipment | 110 6th Ave Se Ste 106, Aberdeen, SD 57401 | 2014-05-12 |
1184059412 | Richard Allen Ward IIi | Hearing Instrument Specialist | 1315 6th Avenue Se, Suite 4, Aberdeen, SD 57401 | 2013-09-05 |
1427395540 | Matthew William Svensen | Physical Therapist | 1109 S Jay St, Aberdeen, SD 57401 | 2013-01-09 |
1750655940 | Robert Ashly Froke | Audiologist | 121 4th Ave Sw-suite 1, Natural Hearing Center, Aberdeen, SD 57401 | 2012-03-06 |
1457504862 | Rodney S Johnson | Counselor | 14 S Main St Ste 1e, Aberdeen, SD 57401 | 2008-10-29 |
1518115005 | Dakota Chiropractic of Aberdeen, PC | Chiropractor | 520 Moccasin Drive, Aberdeen, SD 57401 | 2008-09-09 |
1558554626 | Tiffany Zimmerman Hoeft | Speech-Language Pathologist | 39515 Pintail Ave, Aberdeen, SD 57401 | 2007-08-22 |
Find all providers in zip 57401 |
Taxonomy Code | 2085R0001X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Radiology |
Specialization | Radiation Oncology |
A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
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 Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578794715 | Troy Edward Adolfson | Radiology | 620 3rd Ave Se, Aberdeen, SD 57401-4554 | 2009-08-06 |
1659487999 | Enrique Flores Mendoza | Radiology | 305 S State St, Aberdeen, SD 57401 | 2006-08-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396067948 | Ronald G Drummond | Radiology | 1910 Highwood Road, Rapid City, SD 57701 | 2010-02-24 |
1760625768 | Kyle Owen Arneson | Radiology | 1000 E 23rd St Ste 100, Sioux Falls, SD 57105-2114 | 2009-04-07 |
1346339777 | Michael E Peterson Md PC | Radiology | 605 N Foster, Mitchell, SD 57301-2902 | 2006-10-12 |
1336238757 | Michael E Peterson | Radiology | 1115 W 9th St, Yankton, SD 57078-3310 | 2006-10-12 |
1568427144 | Stephen Dick | Radiology | 605 N Foster St, Mitchell, SD 57301-2902 | 2006-04-18 |
1457347007 | Daniel Martin Tackett | Radiology | 3751 Skyline Dr, Rapid City, SD 57701-5363 | 2005-09-20 |
1962927269 | Avera Queen of Peace | Radiology | 605 N Foster St, Mitchell, SD 57301-2902 | 2017-08-08 |
1346529211 | Sanford Clinic | Radiology | 1309 W 17th St, Sioux Falls, SD 57104-4663 | 2011-08-10 |
1477847861 | Avera Mckennan | Radiology | 1000 E. 23rd St., Ste. 100, Sioux Falls, SD 57105-2113 | 2011-06-03 |
1710270061 | Joel L Grow | Radiology | 1000 E 23rd St Ste 100, Sioux Falls, SD 57105-2114 | 2011-05-19 |
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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.