Provider Demographics
NPI:1669457180
Name:AVERA ST MARYS
Entity Type:Organization
Organization Name:AVERA ST MARYS
Other - Org Name:AVERA ST. MARY'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-3144
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:STE PFS PROV ENROLLMENT
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-6428
Mailing Address - Fax:
Practice Address - Street 1:801 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3323
Practice Address - Country:US
Practice Address - Phone:605-224-3100
Practice Address - Fax:605-224-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10556282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0100150Medicaid
80015OtherBCBS
SD5500150Medicaid
80015OtherBCBS
SD0100150Medicaid
SD435034Medicare Oscar/Certification
SD430015Medicare Oscar/Certification
SD5500150Medicaid
SD435034Medicare Oscar/Certification