AVERA MEDICAL GROUP CORSICA – NPI #1932105046
Clinic/Center

AVERA MEDICAL GROUP CORSICA is an AHC clinic located in CORSICA, SD. NPPES has assigned the NPI number 1932105046 to AVERA MEDICAL GROUP CORSICA on June 23, 2005. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “AVERA MEDICAL GROUP CORSICA” is a dba name, the actual legal business name for this organization is AVERA QUEEN OF PEACE. The primary taxonomy selected by this provider is 261QR1300X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Rural Health

The NPI profile was previously updated about 6 years ago on Aug 20, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for AVERA MEDICAL GROUP CORSICA below.

NPI Profile for
AVERA QUEEN OF PEACE

NPI Number
1932105046
Enumeration Date

(about 21 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
AVERA QUEEN OF PEACE
Doing Business As (dba): AVERA MEDICAL GROUP CORSICA
Primary location
265 MAIN STREET
CORSICA, SD 57328
Phone: (605) 946-5411 Fax: (605) 946-5206
Mailing address
525 N FOSTER ST
MITCHELL, SD 57301-2966
Phone: (605) 995-2000 Fax: (605) 995-2441
Organization Subpart
No
Authorized Official
DOUGLAS EKEREN
PRESIDENT/CEO
Phone: (605) 668-8322
Updated
Certification Date
Aug 20, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for AVERA MEDICAL GROUP CORSICA

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

See identifiers
DescriptionIssuerStateIdentifier
OTHERMEDICASD00-00435
OTHERMEDICARE RRSDCR0890
OTHERMULTIPLANSDA-87545
OTHERWELLMARKSD0000018
MEDICAIDSD5306742
MEDICAIDSD5306743
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QR1300X
- Clinic/Center / Rural Health (Primary)
SD N/A

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.