| NPI | 1174548937 |
|---|---|
| Doing Business As | AVERA ST LUKES PHYSICIAN SPECIALIST CLINIC |
| Entity Type | Organization |
| Authorized Contact | RON JACOBSON President 605-622-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 246R00000X Technician, Pathology |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |