Avera Queen of Peace
Organization Active NPI Registered Dietitian · Mitchell, SD
NPI 1598094823 · NPPES record last updated Sep 14, 2020
Key facts
- NPI
- 1598094823
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Registered Dietitian 133V00000X
- Legal business name
- AVERA QUEEN OF PEACE
- Practice address
- 525 N Foster St
Mitchell, SD 57301-2966 - Phone
- (605) 995-2000
- Fax
- (605) 995-2441
- NPI assigned
- Dec 16, 2009
- Organization subpart
- No
Authorized official
- Name
- Douglas Ekeren
- Title
- President/Ceo
- Phone
- (605) 668-8321
Corporate family (same tax ID) 28
National Provider Directory
- Tax ID family
- ER Phy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | Yes |
Addresses
Primary practice location
525 N Foster St
Mitchell, SD 57301-2966
Mailing address
525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5590320 | Medicaid | SD |
Other providers in Mitchell, SD
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
All providers in Mitchell, SD · Registered Dietitian in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.