AVERA MCKENNAN (NPI# 1588677892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588677892 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP REVILLO |
| Practice Address |
305 N 2nd Ave Revillo SD 57259-0006 |
| Mailing Address |
901 E Virgil Ave Milbank SD 57252-2124 |
| Practice Telephone | 6056234695 |
| Practice Fax Number | 6056234318 |
| Mailing Telephone | 6054324538 |
| Mailing Fax Number | 6054325412 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-03-31 |
| Authorized Official Name | JULIE NORTON (VP/CFO) |
| Authorized Official Telephone | 6053226375 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
SD | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 246933200 | 05 | |
| MN | MN BLUE CROSS-REVILLO P# | 228L6RE | 01 |
| SD | 5800490 | 05 | |
| SD | DAKOTACARE REVILLO PROV# | 9204609 | 01 |
| SD | SD BLUE CROSS-REVILLO P# | 4996359 | 01 |
| Other Name | Type Code |
|---|---|
| AVERA MEDICAL GROUP REVILLO | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154979805 | Avera Mckennan | Substance Abuse Rehabilitation Facility | 6140 S Curae Lane, Sioux Falls, SD 57108-3047 | 2019-08-27 |
| 1205311628 | Avera Mckennan | Pharmacy | 6100 S Louise Ave Ste 1100, Sioux Falls, SD 57108-6021 | 2018-10-02 |
| 1316463219 | Avera Mckennan | Pharmacy | 1200 S. 7th Avenue, Suite 101, Sioux Falls, SD 57105 | 2017-08-22 |
| 1851848444 | Avera Mckennan | Durable Medical Equipment & Medical Supplies | 2100 S Marion Road, Ste 125, Sioux Falls, SD 57106-3645 | 2016-09-01 |
| 1295187417 | Avera Mckennan | Psychiatry & Neurology | 6709 S. Minnesota Ave., Ste. 103, Sioux Falls, SD 57108-2593 | 2016-07-12 |
| 1669871000 | Avera Mckennan | Durable Medical Equipment & Medical Supplies | 3820 N Potsdam Ave Ste 2, Sioux Falls, SD 57104-7057 | 2014-08-21 |
| 1922413806 | Avera Mckennan | Clinic/Center | 400 2nd Ave, Brookings, SD 57006 | 2014-06-30 |
| 1629499132 | Avera Mckennan | Occupational Therapist | 1601 W 44th Pl, Sioux Falls, SD 57105-6376 | 2013-12-31 |
| 1700146396 | Avera Mckennan | Clinic/Center | 1035 South Highline Pl, Ste #4, Sioux Falls, SD 57110 | 2012-05-17 |
| 1467711739 | Avera Mckennan | Pharmacy | 1301 S Cliff Ave Ste 225, Sioux Falls, SD 57105-1068 | 2012-05-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | AVERA MCKENNAN | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 |
| Iowa Business Entities | AVERA MCKENNAN | 1325 S. Cliff St., Sioux Falls, SD 57105 |
| System for Award Management (SAM) Entities | AVERA MCKENNAN HOSPITAL & UNIVERSITY HEALTH CENTER | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 |
| Street Address |
305 N 2ND AVE |
| City | REVILLO |
| State | SD |
| Zip Code | 57259-0006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033393251 | Grant-deuel School District | Local Education Agency (LEA) | 16370 482 Avenue, Revillo, SD 57259 | 2007-12-24 |
| 1134299100 | Peggy Jo Schuelke | Nurse Practitioner | 103 E. Third Street, Revillo, SD 57259 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033393251 | Grant-deuel School District | Local Education Agency (LEA) | 16370 482 Avenue, Revillo, SD 57259 | 2007-12-24 |
| 1134299100 | Peggy Jo Schuelke | Nurse Practitioner | 103 E. Third Street, Revillo, SD 57259 | 2006-11-08 |
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447803432 | City of Brookings | Clinic/Center | 104 1/2 West 2nd Street, Elkton, SD 57026 | 2019-07-19 |
| 1477942878 | Platte Community Memorial Hospital, Inc | Clinic/Center | 306 S Johnston St, White Lake, SD 57383-2251 | 2015-01-22 |
| 1003230541 | Regional Health Physicians, Inc. | Clinic/Center | 112 7th Avenue, Wall, SD 57790 | 2014-02-04 |
| 1912279829 | City of Brookings | Clinic/Center | 302 E 5th Street, White, SD 57276-2061 | 2012-02-08 |
| 1902187032 | Community Memorial Hospital Inc | Clinic/Center | 314 Mellette St, Bonesteel, SD 57317 | 2011-09-02 |
| 1609013317 | Douglas County Memorial Hospital | Clinic/Center | 310 W Sd Highway 46, Wagner, SD 57380-9304 | 2009-01-16 |
| 1750422655 | Regional Health Physicians Inc | Clinic/Center | 114 E Main Street, Hill City, SD 57745 | 2007-02-12 |
| 1326189754 | Regional Health Physicians Inc | Clinic/Center | 101 E. Third St., Newell, SD 57760 | 2007-02-09 |
| 1609931518 | Sioux Valley Clinic | Clinic/Center | 600 W Cedar Street (highway 46), Beresford, SD 57004 | 2006-12-22 |
| 1912916438 | Linton Hospital | Clinic/Center | 517 Ave B, Pollick, SD 57648 | 2006-08-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.