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General NPI Number Information
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NPI Number | 1851336887
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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 | 06/16/2006
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Last Update Date | 05/31/2017
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Provider Practice Location Address
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Address Line | 1436 E 10TH ST
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City | WINNER
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State | SD
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Zip | 57580-2818
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Country | US
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Telephone | 605-842-2443
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Fax | 605-842-1650
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Provider Business Mailing Address
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Address Line | 1436 E 10TH ST STE #2
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City | WINNER
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State | SD
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Zip | 57580-2875
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Country | US
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Telephone | 605-842-2443
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Fax | 605-842-1650
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Authorized Official
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Title or Position | CFO/SVP
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Name | JULIE 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3344
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License Number State | SD
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