Provider Demographics
NPI:1629254495
Name:SACRED HEART HEALTH SERVICES
Entity Type:Organization
Organization Name:SACRED HEART HEALTH SERVICES
Other - Org Name:AVERA MEDICAL GROUP RADIATION ONCOLOGY YANKTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
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:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-4933
Mailing Address - Fax:605-504-9489
Practice Address - Street 1:1115 W 9TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3310
Practice Address - Country:US
Practice Address - Phone:605-668-8850
Practice Address - Fax:605-668-9448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRED HEART HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDF34226Medicare UPIN
SDS31012Medicare PIN
SDCN2219Medicare PIN
SDCD1529Medicare PIN