AVERA MCKENNAN NPI 1467786640

NPI Information

NPI: 1467786640
Provider Name: AVERA MCKENNAN

Doing Business As: AVERA PRINCE OF PEACE OUTPATIENT THERAPY

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
4513 S PRINCE OF PEACE PL STE 1
SIOUX FALLS, SD
ZIP 57103
Phone: (605) 322-5618
Get Directions

AVERA MCKENNAN is a multi-specialty clinic center in Sioux Falls, SD. AVERA MCKENNAN NPI is 1467786640. The provider is registered as an organization entity type.
The provider Is Doing Business As Avera Prince Of Peace Outpatient Therapy.

The provider's business location address is:

4513 S PRINCE OF PEACE PL STE 1
SIOUX FALLS, SD
ZIP 57103-830
Phone: (605) 322-5618

The provider's authorized official is David Flicek .
The authorized official title is President and has the following contact phone number (605) 322-7915.

The enumeration date for this NPI number is 9/22/2009 and was last updated on 7/1/2021.

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	261QM1300X	Clinic/Center	Multi-Specialty	10563	SOUTH DAKOTA	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	10025846600 (PT )	MEDICAID	NEBRASKA
2	9290262	OTHER	SOUTH DAKOTA	DAKOTACARE
3	1467786640	MEDICAID	MINNESOTA
4	10025846700 (OT GRP)	MEDICAID	NEBRASKA
5	1467786640	MEDICAID	IOWA

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

NPI Synchronization or Removal

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