MEDICARE: AVERA MCKENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0000028	OTHER	SD	WELLMARK BC/BS

General Provider Information

NPI Number	:	1568492551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	PO BOX 319
Second Line	:	730 WILSON ST
City	:	BUTTE
State	:	NE
Zip	:	68722-0319
Country	:	US
Telephone Number	:	402-775-2174
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 WILSON ST
Second Line	:
City	:	BUTTE
State	:	NE
Zip	:	68722-0319
Country	:	US
Telephone Number	:	402-775-2174
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	JULIE N NORTON
Credential	:
Telephone Number	:	605-322-6375

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	04/25/2011

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Directions to “AVERA MCKENNAN ” Practice Location

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