AVERA MCKENNAN NPI 1104892892

NPI Information

NPI: 1104892892
Provider Name: AVERA MCKENNAN

Doing Business As: AVERA MEDICAL GROUP NEPHROLOGY SIOUX FALLS

Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

Address:
1315 S. CLIFF AVE.
STE. 2000
SIOUX FALLS, SD
ZIP 57105
Phone: (605) 322-5800
Get Directions

AVERA MCKENNAN is a nephrology internal medicine in Sioux Falls, SD. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. AVERA MCKENNAN NPI is 1104892892. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Avera Medical Group Nephrology Sioux Falls.

The provider's business location address is:

1315 S. CLIFF AVE.
STE. 2000
SIOUX FALLS, SD
ZIP 57105-058
Phone: (605) 322-5800
Fax: (605) 322-5801

The provider's authorized official is David Flicek .
The authorized official title is Ceo/president and has the following contact phone number (605) 322-8000.

The enumeration date for this NPI number is 2/23/2006 and was last updated on 10/24/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RN0300X	Internal Medicine	Nephrology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0008493	OTHER	SOUTH DAKOTA	BCBS
2	9191250	OTHER	SOUTH DAKOTA	DAKOTACARE
3	12903	MEDICAID	NORTH DAKOTA
4	=========44	MEDICAID	NEBRASKA
5	031013001	OTHER	MINNESOTA	PRIMEWEST
6	118T5NO	OTHER	MINNESOTA	BLUE PLUS
7	118T5NO	OTHER	MINNESOTA	BCBS
8	370624200	OTHER	SOUTH DAKOTA	DEPT OF LABOR
9	0550814	MEDICAID	IOWA
10	81741	OTHER	SOUTH DAKOTA	HEALTHPARTNERS
11	210830500	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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