Provider Demographics
NPI:1164205340
Name:AVERA QUEEN OF PEACE
Entity Type:Organization
Organization Name:AVERA QUEEN OF PEACE
Other - Org Name:AVERA MEDICAL GROUP PAIN MANAGEMENT MITCHELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-995-2250
Mailing Address - Street 1:PO BOX 860674
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0001
Mailing Address - Country:US
Mailing Address - Phone:605-995-2234
Mailing Address - Fax:605-995-5779
Practice Address - Street 1:525 N FOSTER ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2999
Practice Address - Country:US
Practice Address - Phone:605-995-2234
Practice Address - Fax:605-995-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty