| NPI | 1871728501 |
|---|---|
| Doing Business As | AVERA ST. LUKE'S FASTCARE SHOPKO |
| Entity Type | Organization |
| Authorized Contact | RON L JACOBSON President & CEO 605-622-5125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 10525) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2011-06-29 |