MEDICARE: AVERA MCKENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		SD

General Provider Information

NPI Number	:	1255309589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	111 10TH STREET EAST
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1208
Country	:	US
Telephone Number	:	605-428-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 10TH STREET EAST
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-1208
Country	:	US
Telephone Number	:	605-428-5446
Fax Number	:

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

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	07/21/2022

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Directions to “AVERA MCKENNAN ” Practice Location

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