AVERA ST. LUKE'S (NPI# 1205090206) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205090206 |
| Entity Type | Organization |
| Organization Name | AVERA ST. LUKE'S |
| Other Organization Name | AVERA MEDICAL GROUP UROLOGY ABERDEEN |
| Practice Address |
310 S Penn St Ste 203 Aberdeen SD 57401-4553 |
| Mailing Address |
Po Box 1460 Aberdeen SD 57402-1460 |
| Practice Telephone | 6052257326 |
| Practice Fax Number | 6052292774 |
| Mailing Telephone | 6056222857 |
| Mailing Fax Number | 6056222852 |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2020-04-02 |
| Authorized Official Name | DEBBIE STREIER (VICE PRESIDENT) |
| Authorized Official Telephone | 6056222807 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 208800000X | Urology | 10525 | SD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DAKOTACARE | 9262425 | 01 | |
| ND | 14895 | 05 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Urology Aberdeen | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336483551 | Avera St. Luke's | Internal Medicine | 310 S Penn St Ste 106, Aberdeen, SD 57401-4553 | 2012-11-15 |
| 1558624668 | Avera St. Luke's | Family Medicine | 501 Bloemendaal Drive, Ipswich, SD 57451 | 2012-06-22 |
| 1619273927 | Avera St. Luke's | Surgery | 4141 31st Ave S Ste 105, Fargo, ND 58104-8778 | 2011-02-03 |
| 1013143296 | Avera St. Luke's | Family Medicine | 105 S State St Ste 113, Aberdeen, SD 57401-4502 | 2009-06-02 |
| 1215100813 | Avera St. Luke's | Dietitian, Registered | 105 S State St Ste 201, Aberdeen, SD 57401-4502 | 2008-04-04 |
| 1154346625 | Avera St. Luke's | Family Medicine | 4401 Main St, Selby, SD 57472 | 2006-07-13 |
| 1124459391 | Avera St. Luke's | Orthopaedic Surgery | 701 8th Ave Nw, Aberdeen, SD 57401 | 2013-12-12 |
| 1982030177 | Avera St. Luke's | Physician Assistant | 815 1st Ave Se, Aberdeen, SD 57401-4602 | 2013-09-19 |
| 1083051817 | Avera St. Luke's | Anesthesiology | 815 1st Ave Se, Aberdeen, SD 57401 | 2013-06-03 |
| 1912265489 | Avera St. Luke's | Internal Medicine | 310 S Penn St, Ste 203, Aberdeen, SD 57401 | 2012-05-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AVERA ST LUKE'S HOSPITAL | 305 S State, Aberdeen, SD 57401-4527 |
| Street Address |
310 S PENN ST STE 203 |
| City | ABERDEEN |
| State | SD |
| Zip Code | 57401-4553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477594430 | Avera St. Lukes | Internal Medicine | 310 S Penn St Ste 203, Aberdeen, SD 57401-4553 | 2006-06-09 |
| 1871771279 | Avera St. Luke's | Podiatrist | 310 S Penn St Ste 203, Aberdeen, SD 57401-4553 | 2008-02-07 |
| 1952438996 | Chad Edward Stapp | Podiatrist | 310 S Penn St Ste 203, Aberdeen, SD 57401-4553 | 2007-02-27 |
| 1295822104 | Eric Samuel Leichter | Urology | 310 S Penn St Ste 203, Aberdeen, SD 57401-4553 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679002950 | Brenda Lee Pence | Registered Nurse | 305 S. State St., Aberdeen, SD 57401 | 2017-06-08 |
| 1104366475 | Jordan Shangreaux | Specialist/Technologist | 2200 S Roosevelt St, Aberdeen, SD 57401 | 2017-03-06 |
| 1205387545 | Midwest Medical Transport Company, LLC-aberdeen, Sd | Ambulance | 2919 Industrial Avenue, Aberdeen, SD 57401 | 2016-10-21 |
| 1356752471 | Cameron Eichler Enterprises | Hearing Aid Equipment | 110 6th Ave Se Ste 106, Aberdeen, SD 57401 | 2014-05-12 |
| 1184059412 | Richard Allen Ward IIi | Hearing Instrument Specialist | 1315 6th Avenue Se, Suite 4, Aberdeen, SD 57401 | 2013-09-05 |
| 1427395540 | Matthew William Svensen | Physical Therapist | 1109 S Jay St, Aberdeen, SD 57401 | 2013-01-09 |
| 1750655940 | Robert Ashly Froke | Audiologist | 121 4th Ave Sw-suite 1, Natural Hearing Center, Aberdeen, SD 57401 | 2012-03-06 |
| 1457504862 | Rodney S Johnson | Counselor | 14 S Main St Ste 1e, Aberdeen, SD 57401 | 2008-10-29 |
| 1518115005 | Dakota Chiropractic of Aberdeen, PC | Chiropractor | 520 Moccasin Drive, Aberdeen, SD 57401 | 2008-09-09 |
| 1558554626 | Tiffany Zimmerman Hoeft | Speech-Language Pathologist | 39515 Pintail Ave, Aberdeen, SD 57401 | 2007-08-22 |
| Find all providers in zip 57401 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881006807 | Roy Donald Duncan | Urology | 300 Forrest Hill Cir, Aberdeen, MS 39730-2147 | 2014-05-26 |
| 1851654768 | Carlton Kom | Urology | 215 9th Ave Se, Aberdeen, SD 57401-6161 | 2012-06-18 |
| 1295822104 | Eric Samuel Leichter | Urology | 310 S Penn St Ste 203, Aberdeen, SD 57401-4553 | 2006-10-10 |
| 1962423418 | Charles Best | Urology | 1006 N H St, Aberdeen, WA 98520-2521 | 2006-07-21 |
| 1801846704 | Stephen Bernard Reznicek | Urology | 1006 North H Street, Aberdeen, WA 98520 | 2006-05-11 |
| 1184681108 | Paul C Eckrich | Urology | 201 S Lloyd St, Suite E105, Aberdeen, SD 57401-4552 | 2006-04-26 |
| 1568428746 | Jerome A Eckrich Jr. | Urology | 201 S Lloyd St, Suite E105, Aberdeen, SD 57401-4552 | 2006-04-25 |
| 1427014646 | Paul Eckrich Md PC | Urology | 201 S Lloyd St, E105, Aberdeen, SD 57401-4552 | 2006-04-25 |
| 1679557391 | Melissa R Brown | Urology | 3015 3rd Ave Se, Aberdeen, SD 57401-5418 | 2005-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508284506 | Timothy Vanadurongvan | Urology | 715 Ballard Ct, Vermillion, SD 57069-7029 | 2014-04-07 |
| 1053583468 | Alexander Murray Mcbride | Urology | 945 Country Club Dr, Spearfish, SD 57783-3102 | 2008-03-25 |
| 1477740942 | Dakota Urology Clinic PC | Urology | 2200 North Kimball Street, Suite 900, Mitchell, SD 57301 | 2007-09-28 |
| 1275654782 | Eugene S Park | Urology | 201 W 69th Street, Sioux Falls, SD 57108-2424 | 2007-04-02 |
| 1518006931 | Larry Alan Meyer | Urology | 2602 Mulberry St, Yankton, SD 57078-4854 | 2007-02-05 |
| 1528130085 | Dileep S Bhat | Urology | 2200 North Kimball, Suite 900, Mitchell, SD 57301 | 2006-11-13 |
| 1588754626 | Rama K.t Varma | Urology | Veterans Administration Medical Center - Fort Meade, 113 Comanche Rd, Fort Meade, SD 57741 | 2006-10-12 |
| 1871687442 | Christine Lynne Bradbury | Urology | 500 North 5th Street, Hot Springs, SD 57747 | 2006-10-03 |
| 1306943576 | Xenofon Papadopoulos | Urology | 1900 Grassland Dr, Mitchell, SD 57301-6335 | 2006-09-20 |
| 1689779068 | Yankton Urological Surgery LLC | Urology | 2009 Locust St, Yankton, SD 57078-2030 | 2006-09-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.