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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1609848175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	2400 S MINNESOTA AVE.
Second Line	:	STE 100
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-3762
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	911 E 20TH ST
Second Line	:	STE. 403
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1042
Country	:	US
Telephone Number	:	605-322-7516
Fax Number	:	605-322-7519

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/27/2012

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Directions to “AVERA MCKENNAN ” Practice Location

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