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General NPI Number Information
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NPI Number | 1699005074
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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 | 01/06/2010
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 930 E 6TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57103-1306
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Country | US
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Telephone | 605-367-7620
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Fax | 605-322-4910
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Provider Business Mailing Address
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Address Line | PO BOX 86430
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City | SIOUX FALLS
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State | SD
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Zip | 57118-6430
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Country | US
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Telephone | 605-322-4900
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Fax | 605-322-4910
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Authorized Official
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Title or Position | CFO/SVP
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Name | JULIE N. NORTON
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Credential |
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Telephone | 605-322-7818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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