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General NPI Number Information
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NPI Number | 1760560452
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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 | 11/01/2006
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 203 N ELK ST
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City | ELKTON
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State | SD
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Zip | 57026-2124
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Country | US
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Telephone | 605-542-7701
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Fax | 605-542-7291
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Provider Business Mailing Address
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Address Line | 212 N PRAIRIE ST
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City | FLANDREAU
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State | SD
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Zip | 57028-1243
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Country | US
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Telephone | 605-997-2741
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Fax | 605-997-2418
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT OF FINANCE
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Name | MRS. 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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