| Avera St Lukes | |
|
240 Main St Ellendale ND 58436 | |
| (701) 349-3666 | |
| (701) 349-4945 |
| Full Name | Avera St Lukes |
|---|---|
| Speciality | Clinic/Center |
| Location | 240 Main St, Ellendale, North Dakota |
| Authorized Official Name and Position | Daniel J Bjerknes (PRESIDENT/CEO) |
| Authorized Official Contact | 6056225125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avera St Lukes Po Box 86370 Sioux Falls SD 57118-6370 Ph: (605) 322-4933 | Avera St Lukes 240 Main St Ellendale ND 58436 Ph: (701) 349-3666 |
| NPI Number | 1760423057 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 05/22/2024 |
| Medicare PECOS PAC ID | 6406764927 |
|---|---|
| Medicare Enrollment ID | O20050726000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760423057 | NPI | - | NPPES |
| 1451171 | Medicaid | ND | |
| 1009046 | Medicaid | SD | |
| N70860 | Other | ND | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Donald J Frisco |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1255337846 PECOS PAC ID: 1355349531 Enrollment ID: I20080414000480 |
| Provider Name | James B Macdougall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1235135823 PECOS PAC ID: 6204729320 Enrollment ID: I20100915000981 |
| Provider Name | Debra K Vivatson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720355233 PECOS PAC ID: 5991968638 Enrollment ID: I20120517000011 |
| Provider Name | Jonathan J Olson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881981561 PECOS PAC ID: 1759500192 Enrollment ID: I20150120000376 |
| Provider Name | Jessica A Bierschbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790160570 PECOS PAC ID: 3375859507 Enrollment ID: I20151012001381 |
| Provider Name | Garret M Wobst |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1124376389 PECOS PAC ID: 0941448351 Enrollment ID: I20170728000554 |
| Provider Name | Pauline M Conway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710338892 PECOS PAC ID: 1052606522 Enrollment ID: I20180202002099 |
| Provider Name | Maria E Jungemann |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1184069460 PECOS PAC ID: 0143456509 Enrollment ID: I20180914002079 |
| Provider Name | Sarah A Siebert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760968085 PECOS PAC ID: 8325391063 Enrollment ID: I20181030003408 |
| Provider Name | Sarah Frauenberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750943783 PECOS PAC ID: 2062845712 Enrollment ID: I20191210003020 |
| Provider Name | Kelsey J Cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184218208 PECOS PAC ID: 5294144606 Enrollment ID: I20210513002970 |
| Provider Name | Kendra D Waldner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770299406 PECOS PAC ID: 1254705882 Enrollment ID: I20231006001034 |
Sanford Medical Center Fargo Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 141 Main Street, Ellendale, ND 58436 Phone: 701-349-3331 Fax: 701-349-3212 |