AVERA BRADY DME SUPPLIER – NPI #1033114731
Durable Medical Equipment & Medical Supplies

AVERA BRADY DME SUPPLIER is a DME supplier located in MITCHELL, SD. NPPES has assigned the NPI number 1033114731 to AVERA BRADY DME SUPPLIER on June 17, 2005. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “AVERA BRADY DME SUPPLIER” is a dba name, the actual legal business name for this organization is AVERA QUEEN OF PEACE. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 332BP3500X from the Health Care Provider Taxonomy code set, which is classified as Durable Medical Equipment & Medical Supplies, specializing in Parenteral & Enteral Nutrition

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 BRADY DME SUPPLIER below.

NPI Profile for
AVERA QUEEN OF PEACE

NPI Number
1033114731
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 BRADY DME SUPPLIER
Primary location
500 S OHLMAN ST
MITCHELL, SD 57301-3109
Phone: (605) 996-7701 Fax:
Mailing address
525 N FOSTER ST
MITCHELL, SD 57301-2966
Phone: (605) 995-2000 Fax:
Organization Subpart
Yes - AVERA BRADY DME SUPPLIER is subpart of another organization.
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.

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
332BP3500X
- Durable Medical Equipment & Medical Supplies / Parenteral & Enteral Nutrition (Primary)		 SD N/A
332B00000X
- Durable Medical Equipment & Medical Supplies		 SD 10652

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.