Provider Demographics
NPI:1013024009
Name:AVERA MCKENNAN
Entity Type:Organization
Organization Name:AVERA MCKENNAN
Other - Org Name:MILBANK AREA HOSPITAL AFTER HOURS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-322-6375
Mailing Address - Street 1:301 FLYNN DR
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1502
Mailing Address - Country:US
Mailing Address - Phone:605-432-4538
Mailing Address - Fax:605-432-5412
Practice Address - Street 1:301 FLYNN DR
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1502
Practice Address - Country:US
Practice Address - Phone:605-432-4538
Practice Address - Fax:605-432-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48451261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413S6MIOtherMN BLUE CROSS-AHC PROV#
SD4996299OtherSD BLUE CROSS AHC PROV#
SD9204610OtherDAKOTACARE AHC PROV#
SDS41135Medicare PIN