Healthcare Provider Details

I. General information

NPI: 1255309589
Provider Name (Legal Business Name): AVERA MCKENNAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 10TH STREET EAST
DELL RAPIDS SD
57022-1208
US

IV. Provider business mailing address

111 10TH STREET EAST
DELL RAPIDS SD
57022-1208
US

V. Phone/Fax

Practice location:
  • Phone: 605-428-5446
  • Fax:
Mailing address:
  • Phone: 605-428-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateSD

VIII. Authorized Official

Name: MRS. JULIE N NORTON
Title or Position: SENIOR VICE PRESIDENT OF FINANCE
Credential:
Phone: 605-322-6375