Avera Queen of Peace

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

AVERA QUEEN OF PEACE

Doing business as

Avera Grassland Diagnostics

Practice address

1900 Grassland Dr.
Mitchell, SD 57301-6205

Phone

(605) 995-7000

NPI assigned

Feb 17, 2011

Last updated

Aug 20, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Douglas Ekeren

Title

President/Ceo

Phone

(605) 668-8322

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Avera Grassland Diagnostics Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1649577297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000",
            "fax_number": "605-995-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 GRASSLAND DR.",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573016205",
            "telephone_number": "605-995-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-17",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "EKEREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-668-8322"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "SD",
            "license": "63654",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649577297",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Grassland Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Grassland Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Avera Queen of Peace
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• Avera Queen of Peace (Avera Ear, Nose and Throat Mitchell)
• Avera Queen of Peace (Avera Queen of Peace Hospital)
• Avera Queen of Peace (Avera Advanced Physical Therapy)
• Avera Queen of Peace (Avera Medical Group Orthopedics & Sports Medicine)
• Avera Queen of Peace (Avera Medical Group Orthopedics & Sports Medicine)
• Avera Queen of Peace (Avera Grassland Pharmacy)

• Clinical Medical Laboratory in Mitchell, SD
• Providers in Mitchell, SD by specialty
• Clinical Medical Laboratory in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.