| Avera Medical Group Pierre A Department Of Avera St Marys Hospital | |
|
801 E Sioux Ave Pierre SD 57501-3323 | |
| (605) 224-5901 | |
| (605) 945-3244 |
| Full Name | Avera Medical Group Pierre A Department Of Avera St Marys Hospital |
|---|---|
| Speciality | Clinic/Center |
| Location | 801 E Sioux Ave, Pierre, South Dakota |
| Authorized Official Name and Position | Shantel Krebs (CEO) |
| Authorized Official Contact | 6052243144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avera Medical Group Pierre A Department Of Avera St Marys Hospital Po Box 86370 Sioux Falls SD 57118-6370 Ph: (605) 322-4933 | Avera Medical Group Pierre A Department Of Avera St Marys Hospital 801 E Sioux Ave Pierre SD 57501-3323 Ph: (605) 224-5901 |
| NPI Number | 1720326713 |
|---|---|
| Provider Enumeration Date | 01/25/2013 |
| Last Update Date | 04/24/2023 |
| Medicare PECOS PAC ID | 0143134965 |
|---|---|
| Medicare Enrollment ID | O20200129001386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720326713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 282N00000X | General Acute Care Hospital | (* (Not Available)) | Secondary |
| Provider Name | Matthew R Casey |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740227933 PECOS PAC ID: 4385656149 Enrollment ID: I20140324001233 |
| Provider Name | Ganesh Asaithambi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588807143 PECOS PAC ID: 5698918852 Enrollment ID: I20140717000325 |
| Provider Name | Jesse James Corry |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215964499 PECOS PAC ID: 3577568823 Enrollment ID: I20140729000823 |
| Provider Name | Katherine Esse |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720255367 PECOS PAC ID: 9537385471 Enrollment ID: I20140729001934 |
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