Avera Queen of Peace | NPI 1780689489

Key facts

NPI: 1780689489
Entity type: Organization (NPI type 2)
Primary specialty: Medicare Defined Swing Bed Hospital Unit 275N00000X
License: 10552 (SD)
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: Jun 17, 2005
Organization subpart: Yes
Parent organization (as reported): AVERA QUEEN OF PEACE

Authorized official

Name: Douglas Ekeren
Title: President/Ceo
Phone: (605) 668-8322

National Provider Directory

Part of: ER Phy

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Medicare Defined Swing Bed Hospital Unit	275N00000X	10552	SD	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 names

Avera Queen of Peace Swing Bed Program Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 20, 2020.

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1780689489",
    "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": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000",
            "fax_number": "605-995-2441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA QUEEN OF PEACE",
        "enumeration_date": "2005-06-17",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "SD",
            "license": "10552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Queen of Peace Swing Bed Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Queen of Peace Swing Bed Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

All providers in Mitchell, SD · Medicare Defined Swing Bed Hospital Unit 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.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.