Provider Demographics
NPI:1588005961
Name:AVERA MARSHALL
Entity Type:Organization
Organization Name:AVERA MARSHALL
Other - Org Name:AVERA MEDICAL GROUP REDWOOD FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STREIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-537-9160
Mailing Address - Street 1:506 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1168
Mailing Address - Country:US
Mailing Address - Phone:507-627-7537
Mailing Address - Fax:
Practice Address - Street 1:506 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1168
Practice Address - Country:US
Practice Address - Phone:507-627-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN019545600Medicaid
MN019545600Medicaid