Provider Demographics
NPI:1316942204
Name:AVERA QUEEN OF PEACE
Entity type:Organization
Organization Name:AVERA QUEEN OF PEACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-995-2250
Mailing Address - Street 1:522 N FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3040
Mailing Address - Country:US
Mailing Address - Phone:605-995-2000
Mailing Address - Fax:605-995-2441
Practice Address - Street 1:604 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WESSINGTON SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57382-2134
Practice Address - Country:US
Practice Address - Phone:605-539-1201
Practice Address - Fax:605-539-4580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA QUEEN OF PEACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48209261QC0050X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0100592Medicaid
SD0100592Medicaid