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	251E00000X	Home Health Agency	10563	SD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770791402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	PO BOX 408
Second Line	:	GREGORY HOMECARE DEPT
City	:	GREGORY
State	:	SD
Zip	:	57533-0408
Country	:	US
Telephone Number	:	605-835-8394
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 WILSON ST
Second Line	:
City	:	BUTTE
State	:	NE
Zip	:	68722-0000
Country	:	US
Telephone Number	:	605-835-8394
Fax Number	:

Authorized Official
Title or Position	:	VP/CFO
Name	:	JULIE NORTON
Credential	:
Telephone Number	:	605-322-6375

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	03/12/2010

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Directions to “AVERA MCKENNAN ” Practice Location

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