Provider Demographics
NPI:1003585548
Name:SACRED HEART HEALTH SERVICES
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SERVICES
Other - Org Name:AVERA MEDICAL GROUP WILLCOCKSON EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:EKEREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-8322
Mailing Address - Street 1:PO BOX 860674
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0605
Mailing Address - Country:US
Mailing Address - Phone:605-665-9638
Mailing Address - Fax:605-665-0526
Practice Address - Street 1:415 W 3RD ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4201
Practice Address - Country:US
Practice Address - Phone:605-665-9638
Practice Address - Fax:605-665-0526
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-08
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty