Organization Name: | AVERA MCKENNAN |
NPI Number: | 1538527106 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JULIE NORTON (CFO/SVP) |
Mailing Address: | 310 W Sd Highway 46 Wagner |
State: | SD US |
Postal Code: | 573809304 |
Phone Number: | 6053844980 |
Fax Number: | 6053844990 |
NPI Enumeration Date: | 02/10/2016 |
NPI Last Update Date: | 02/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | 10563 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |