AVERA MCKENNAN NPI 1588997365

NPI Information

NPI: 1588997365
Provider Name: AVERA MCKENNAN

Doing Business As: AVERA BREAST CENTER MOBILE

Classification: Clinic/Center - 261QR0207X
Entity Type: Organization

Specialization: Radiology, Mobile Mammography

Address:
1000 E 23RD ST
SUITE 330
SIOUX FALLS, SD
ZIP 57105
Phone: (605) 322-7465
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AVERA MCKENNAN is a radiology and mobile mammography clinic center in Sioux Falls, SD. AVERA MCKENNAN NPI is 1588997365. The provider is registered as an organization entity type.
The provider Is Doing Business As Avera Breast Center Mobile.

The provider's business location address is:

1000 E 23RD ST
SUITE 330
SIOUX FALLS, SD
ZIP 57105-113
Phone: (605) 322-7465

The provider's authorized official is Ronald Joseph Place .
The authorized official title is President/ceo and has the following contact phone number (605) 322-7903.

The enumeration date for this NPI number is 9/11/2009 and was last updated on 10/4/2023.

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	261QR0207X	Clinic/Center	Radiology, Mobile Mammography	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	1588997365	OTHER	SOUTH DAKOTA	WELLMARK BCBS SD
2	7290300	MEDICAID	SOUTH DAKOTA
3	9290118	OTHER		DAKOTACARE

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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