| NPI | 1558624668 |
|---|---|
| Doing Business As | AVERA MEDICAL GROUP IPSWICH |
| Entity Type | Organization |
| Authorized Contact | TODD FORKEL President And CEO 605-622-5125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |