NPIMap

Organization Active NPI

Avera Queen of Peace

Doing business as Avera Advanced Physical Therapy

  • Physical Therapy Clinic/Center
  • Mitchell, SD
National Provider Identifier
1689051682
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
AVERA QUEEN OF PEACE
Doing business as
Avera Advanced Physical Therapy
Practice address
409 S Ohlman St
Mitchell, SD 57301-3106
Phone
(605) 996-4552
Fax
(605) 996-0577
NPI assigned
Apr 29, 2015
Last updated
Aug 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

409 S Ohlman St
Mitchell, SD 57301-3106

Mailing address

409 S Ohlman St
Mitchell, SD 57301-3106
Phone (605) 996-4552

Other names 1

  • Avera Advanced Physical Therapy Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1689051682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S OHLMAN ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573013106",
            "telephone_number": "605-996-4552",
            "fax_number": "605-996-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 S OHLMAN ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573013106",
            "telephone_number": "605-996-4552",
            "fax_number": "605-996-0577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "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": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Advanced Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Advanced Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.