AVERA QUEEN OF PEACE NPI 1639174568

NPI Information

NPI: 1639174568
Provider Name: AVERA QUEEN OF PEACE

Doing Business As: AVERA MEDICAL GROUP SALEM

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
741 S HILL ST
SALEM, SD
ZIP 57058
Phone: (605) 425-3038
Get Directions

AVERA QUEEN OF PEACE is a rural health clinic center in Salem, SD. AVERA QUEEN OF PEACE NPI is 1639174568. The provider is registered as an organization entity type.
The provider Is Doing Business As Avera Medical Group Salem.

The provider's business location address is:

741 S HILL ST
SALEM, SD
ZIP 57058-761
Phone: (605) 425-3038
Fax: (605) 425-3039

The provider's authorized official is Douglas Ekeren .
The authorized official title is President/ceo and has the following contact phone number (605) 668-8322.

The CLIA number assigned to this NPI record is 43D0406894 - community clinic with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 6/16/2005 and was last updated on 8/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health	N/A	SOUTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CR0890	OTHER	SOUTH DAKOTA	MEDICARE RR
2	00-00592	OTHER	SOUTH DAKOTA	MEDICA
3	5307012	MEDICAID	SOUTH DAKOTA
4	5307010	MEDICAID	SOUTH DAKOTA
5	4998666	OTHER	SOUTH DAKOTA	WELLMARK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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