AVERA ST. LUKE'S (NPI# 1639373756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639373756 |
| Entity Type | Organization |
| Organization Name | AVERA ST. LUKE'S |
| Other Organization Name | MOBRIDGE FAMILY PRACTICE CLINIC |
| Practice Address |
1400 10th Ave W Mobridge SD 57601-1246 |
| Mailing Address |
Po Box 710 Mobridge SD 57601-0710 |
| Practice Telephone | 6058457292 |
| Practice Fax Number | 6058457812 |
| Mailing Telephone | 6058457292 |
| Mailing Fax Number | 6058457812 |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2008-01-18 |
| Authorized Official Name | MR. RON L JACOBSON (CEO) |
| Authorized Official Telephone | 6056225000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 10525 | SD | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Mobridge Family Practice Clinic | 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 |
1400 10TH AVE W |
| City | MOBRIDGE |
| State | SD |
| Zip Code | 57601-1246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174548937 | Avera St Lukes | Radiology | 1400 10th Ave W, Mobridge, SD 57601-1246 | 2006-07-13 |
| 1902248099 | John Charles Olson | Optometrist | 1400 10th Ave W, Mobridge, SD 57601-1246 | 2013-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881761096 | Alfred T Smith | Counselor | 1245 Hwy 1806th, Mobridge, SD 57601 | 2006-11-30 |
| 1912078429 | Carmen J. Cutt | Counselor | 12451 Highway 1806, Mobridge, SD 57601 | 2006-11-13 |
| 1629090162 | Craig Dockter | Optometrist | 1315 10th Ave, Mobridge, SD 57601 | 2006-07-24 |
| 1437786373 | Courtney M Nicholson | Counselor | 12451 Hwy 1806, Mobridge, SD 57601 | 2020-03-23 |
| 1922634062 | Mary Lerae Herman | Registered Nurse | 12451 Hwy 1806, Mobridge, SD 57601 | 2020-03-20 |
| 1063870194 | Karen Fryhling | Nurse Practitioner | 1309 10th Ave W, Mobridge, SD 57601 | 2016-02-03 |
| 1508271115 | Matthew Jacob Schaffer | Family Medicine | 1309 10th Ave W, Mobridge, SD 57601 | 2014-06-23 |
| 1871807206 | Shadow Anesthesia Services, LLC | Clinic/Center | 1401 10th Ave W, Mobridge, SD 57601 | 2010-07-27 |
| 1902051162 | Celeste Anne Karzon | Specialist | 12451 Hwy 1806, Mobridge, SD 57601 | 2008-12-01 |
| 1598975997 | Roxann Dakota Spottedeagle | Counselor | 12451 Hwy 1806, Mobridge, SD 57601 | 2007-05-23 |
| Find all providers in zip 57601 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275502577 | Mobridge Regional Hospital | Family Medicine | 1309 10th Ave West, Mobridge, SD 57601-0520 | 2006-03-17 |
| 1932580917 | Emily Boden | Family Medicine | 1309 10th Ave W, Mobridge, SD 57601-1146 | 2015-06-15 |
| 1508271115 | Matthew Jacob Schaffer | Family Medicine | 1309 10th Ave W, Mobridge, SD 57601 | 2014-06-23 |
| 1902850779 | Regg A Hagge | Family Medicine | 1309 10th Ave W, Mobridge, SD 57601 | 2006-05-19 |
| 1417910373 | Colette A Ducheneaux | Family Medicine | 1309 10th Ave W, Mobridge, SD 57601-1146 | 2006-04-10 |
| 1427030949 | Robert C Marciano | Family Medicine | 1309 10th Ave W, Mobridge, SD 57601-1146 | 2005-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396343505 | Kaitlyn Mae Fritz | Family Medicine | Wellness Center 103, Brookings, SD 57007-0001 | 2020-10-12 |
| 1447877386 | Black Hills Primary Care PC | Family Medicine | 8075 Stage Stop Rd., Summerset, SD 57718 | 2020-06-26 |
| 1467003251 | Arthur Lampert | Family Medicine | 1770 Tablerock Rd Apt 120, Rapid City, SD 57701-5586 | 2019-09-24 |
| 1851883540 | Modern Day Health Care Prof LLC | Family Medicine | 125 Railroad Ave Se, Aberdeen, SD 57401-4202 | 2018-05-30 |
| 1427555002 | Sanford Clinic | Family Medicine | 136 S Phillips Ave Ste 102, Sioux Falls, SD 57104 | 2018-04-10 |
| 1023524741 | Quick Health Urgent Care LLC | Family Medicine | 7600 S Louise Ave Ste 150, Sioux Falls, SD 57108-5999 | 2017-12-18 |
| 1568991446 | Callie Pederson | Family Medicine | 28th Medical Group, 2900 Doolitle Drive, Ellsworth Afb, SD 57706-4821 | 2017-06-05 |
| 1144751256 | Maya Itza Koehler | Family Medicine | 534 Oregon Ave Se, Huron, SD 57350-2801 | 2017-03-22 |
| 1578004883 | Sacred Heart Health Services | Family Medicine | 2525 Fox Run Pkwy Ste 200, Yankton, SD 57078-5371 | 2017-03-20 |
| 1073992004 | Monument Health Network, Inc. | Family Medicine | 209 Ramsland St, Buffalo, SD 57720-0045 | 2015-05-22 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on AVERA ST. LUKE'S.
| 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.