AVERA QUEEN OF PEACE (NPI# 1326283797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326283797 |
| Entity Type | Organization |
| Organization Name | AVERA QUEEN OF PEACE |
| Other Organization Name | AVERA MEDICAL GROUP OBSTETRICS AND GYNECOLOGY |
| Practice Address |
1900 Grassland Dr Mitchell SD 57301-6335 |
| Mailing Address |
Po Box 86074 Minneapolis MN 55486-0001 |
| Practice Telephone | 6059956350 |
| Practice Fax Number | 6059956353 |
| Mailing Telephone | 6059956337 |
| Mailing Fax Number | 6059955779 |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | DOUGLAS EKEREN (PRESIDENT/CEO) |
| Authorized Official Telephone | 6056688322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | MEDICARE PTAN | S1639 | 01 |
| TX | TEXAS MEDICAID | 2127532 | 01 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Obstetrics and Gynecology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568986040 | Avera Queen of Peace | Internal Medicine | 605 N Foster St Ste 100, Mitchell, SD 57301-2902 | 2017-07-27 |
| 1689051682 | Avera Queen of Peace | Clinic/Center | 409 S Ohlman St, Mitchell, SD 57301-3106 | 2015-04-29 |
| 1649577297 | Avera Queen of Peace | Clinic/Center | 1900 Grassland Dr., Mitchell, SD 57301-6205 | 2011-02-17 |
| 1053557967 | Avera Queen of Peace | Physician Assistant | 115 Second St Se, De Smet, SD 57231-0463 | 2008-12-23 |
| 1699972422 | Avera Queen of Peace | Specialist | 625 N Foster St Ste 200, Mitchell, SD 57301-2968 | 2007-06-27 |
| 1992712921 | Avera Queen of Peace | Pharmacy | 609 1st St Ne, Wessington Springs, SD 57382-2136 | 2006-08-02 |
| 1932105046 | Avera Queen of Peace | Clinic/Center | 265 Main Street, Corsica, SD 57328 | 2005-06-23 |
| 1326043092 | Avera Queen of Peace | Clinic/Center | 213 South Main, Howard, SD 57349 | 2005-06-17 |
| 1316942204 | Avera Queen of Peace | Clinic/Center | 604 1st St Ne, Wessington Springs, SD 57382-2134 | 2005-06-16 |
| 1639174568 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2005-06-16 |
| Street Address |
1900 GRASSLAND DR |
| City | MITCHELL |
| State | SD |
| Zip Code | 57301-6335 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306943576 | Xenofon Papadopoulos | Urology | 1900 Grassland Dr, Mitchell, SD 57301-6335 | 2006-09-20 |
| 1952911877 | Nancy Jo Miller | Dietitian, Registered | 1900 Grassland Dr, Mitchell, SD 57301-6335 | 2020-08-05 |
| 1669027678 | Rural Health Care, Inc | Family Medicine | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2019-08-06 |
| 1033762984 | Theresa Miiller | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2019-07-19 |
| 1649831637 | Maggie Riggs | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2019-06-21 |
| 1154896801 | Angela Mae Broughton | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2018-10-09 |
| 1417495649 | Laura Axsom | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2017-02-08 |
| 1881049484 | Avera Queen of Peace | Dermatology | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2016-05-02 |
| 1710359252 | Avera Queen of Peace | Pharmacy | 1900 Grassland Dr, Ste 101, Mitchell, SD 57301 | 2015-10-23 |
| 1780055780 | Lacey Bonte | Nurse Practitioner | 1900 Grassland Dr, Mitchell, SD 57301-6205 | 2015-10-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932721388 | Dakota Counseling Institute | Social Worker | 910 W Havens, Mitchell, SD 57301 | 2020-05-08 |
| 1215588512 | Carolyn Marie Klinkhammer | Registered Nurse | 525 North Foster - Avera Queen of Peace Hospital, Mitchell, SD 57301 | 2019-09-27 |
| 1720596893 | Brian Bannwarth | Pharmacist | 25147 Campground Road, Mitchell, SD 57301 | 2018-01-11 |
| 1336664135 | Haley Long | Speech-Language Pathologist | 200 East Havens, Mitchell, SD 57301 | 2017-08-14 |
| 1770004996 | Edgewood Mitchell LLC | Assisted Living Facility | 501 East Spruce Street, Mitchell, SD 57301 | 2017-06-28 |
| 1467831685 | Amanda Louise Johnson | Physical Therapist | 910 S Edgerton, Mitchell, SD 57301 | 2015-05-20 |
| 1922432830 | Melissa Jill Maier | Dentist | 240 E 23 Ave, Mitchell, SD 57301 | 2013-08-27 |
| 1356626972 | Lewis Family Drug, LLC | Pharmacy | 1507 N Main St, Mitchell, SD 57301 | 2011-10-14 |
| 1184945958 | Kimberly L Lienemann | Counselor | 403 N Lawler St, Mitchell, SD 57301 | 2010-06-16 |
| 1134365554 | Gronsten-maier Dental Prof. LLC | Dentist | 240 E. 23rd Avenue, Mitchell, SD 57301 | 2009-01-07 |
| Find all providers in zip 57301 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538285739 | Dakota Women's Clinic, Michael R. Krause, Do, PC | Obstetrics & Gynecology | 625 N Foster St # 108, Mitchell, SD 57301-2969 | 2007-03-21 |
| 1558471573 | Ronald D Anderson | Obstetrics & Gynecology | 2100 Highland Way Ste K, Mitchell, SD 57301-6409 | 2006-08-30 |
| 1073626115 | Michael Ross Krause | Obstetrics & Gynecology | 625 N Foster St Ste 108, Mitchell, SD 57301-2969 | 2006-08-15 |
| 1205800570 | Elizabeth E Campbell | Obstetrics & Gynecology | 625 N Foster St, Mitchell, SD 57301-2969 | 2006-02-14 |
| 1407858954 | Lonnie Joseph Nedved | Obstetrics & Gynecology | 1200 S Burr St, Mitchell, SD 57301-4584 | 2005-08-15 |
| 1437538303 | Jacob Thomas | Obstetrics & Gynecology | 625 N Foster St, Mitchell, SD 57301-2969 | 2015-05-26 |
| 1053670729 | Julie L. Weigandt | Obstetrics & Gynecology | 2100 Highland Way, Mitchell, SD 57301-6426 | 2012-05-15 |
| 1932496353 | Ashley Faye Peters | Obstetrics & Gynecology | 625 N Foster St, Mitchell, SD 57301-2969 | 2011-07-06 |
| 1477849941 | Dawn Boender | Obstetrics & Gynecology | 625 N Foster St, Suite 107, Mitchell, SD 57301-2969 | 2011-06-23 |
| 1841506110 | Sanford Clinic | Obstetrics & Gynecology | 2100 Highland Way Ste K, Mitchell, SD 57301-6409 | 2010-08-25 |
| Find all providers in MITCHELL | ||||
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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.