Avera Queen of Peace
Organization Active NPI Rural Health Clinic/Center · Salem, SD
NPI 1619201829 · NPPES record last updated Aug 20, 2020
Key facts
- NPI
- 1619201829
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- NA (SD)
- Legal business name
- AVERA QUEEN OF PEACE
- Practice address
- 741 S Hill St
Salem, SD 57058-8761 - Phone
- (605) 425-3038
- Fax
- (605) 425-3039
- NPI assigned
- Sep 22, 2009
- Organization subpart
- No
Authorized official
- Name
- Douglas Ekeren
- Title
- President/Ceo
- Phone
- (605) 668-8322
Other NPIs on the same Medicare enrollment 31
Practitioners 3
-
Joseph Thomas Jordahl, M.D.
-
Michael E Peterson, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031229000301 | SD | Part B Supplier - Clinic/Group Practice | 9335050806 |
Receives reassigned benefits from 252 practitioners 31 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mitchell, SD; Parkston, SD; Pierre, SD; Platte, SD; Sioux Falls, SD; Wagner, SD; Wessington Springs, SD; Yankton, SD… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | NA | SD | Yes |
Addresses
Primary practice location
741 S Hill St
Salem, SD 57058-8761
Mailing address
525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S1639 | Other | SD | MEDICARE PART B |
| 00-00592 | Other | SD | MEDICA |
| 4991003 | Other | SD | WELLMARK |
| 5307012 | Medicaid | SD | |
| CR0890 | Other | SD | MEDICARE RAILROAD |
Other names
- Avera Medical Group Salem
Other providers in Salem, SD
- Vanessa Anderson-Smith
- Emily Judith Anderson
- Avera McKennan
- Avera Queen of Peace
- John Barnett
- Steven Blom
- John Rollin Bosch
- Rachel Reka Brady
All providers in Salem, SD · Rural Health Clinic/Center 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 Aug 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.