Organization · NPI-2
Avera Mckennan
Family Medicine · Sioux Falls, SD
NPI number1134324445
StatusActive
Last updated in NPPESMay 10, 2012
Details
- NPI
- 1134324445
- Entity type
- Organization (NPI-2)
- Legal business name
- Avera Mckennan
- Organization subpart
- No
- Enumeration date
- Jun 18, 2007
- Last updated
- May 10, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Avera Medical Group Mcgreevy 69th & Western (Doing Business As)
Practice location
1910 W 69th StSioux Falls, SD 57108-5612
Phone 605-322-5200 · Fax 605-322-5205
Mailing address
Po Box 86430Sioux Falls, SD 57118-6430
Phone 605-322-4900 · Fax 605-322-4910
Authorized official
Julie N Norton
Sr Vice President Of Finance
6053226375
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