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General NPI Number Information
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NPI Number | 1164780201
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Entity Type | Organization
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Legal Business Name | AVERA MCKENNAN
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 3720 W 69TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57108-8192
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Country | US
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Telephone | 605-339-4464
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Fax | 605-339-0309
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Provider Business Mailing Address
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Address Line | 2400 S MINNESOTA AVE STE 100
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City | SIOUX FALLS
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State | SD
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Zip | 57105-3761
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Country | US
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Telephone | 605-322-7510
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Fax | 605-322-6475
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Authorized Official
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Title or Position | SENIOR VP FINANCE
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Name | JULIE N NORTON
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Credential |
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Telephone | 605-322-6375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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