Provider Demographics
NPI:1326398512
Name:SACRED HEART HEALTH SERVICES
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SERVICES
Other - Org Name:AVERA MEDICAL GROUP LAFLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EKEREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-668-8321
Mailing Address - Street 1:1000 W 4TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-655-1414
Mailing Address - Fax:605-655-1420
Practice Address - Street 1:804 CHASE AVE
Practice Address - Street 2:
Practice Address - City:CREIGHTON
Practice Address - State:NE
Practice Address - Zip Code:68729-2893
Practice Address - Country:US
Practice Address - Phone:402-358-5335
Practice Address - Fax:402-358-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1399OtherMEDICARE