Provider Demographics
NPI:1467791228
Name:AVERA MCKENNAN
Entity Type:Organization
Organization Name:AVERA MCKENNAN
Other - Org Name:AVERA MCGREEVY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT AND CODING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SORTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:605-322-4919
Mailing Address - Street 1:212 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6479
Mailing Address - Country:US
Mailing Address - Phone:605-322-4919
Mailing Address - Fax:
Practice Address - Street 1:212 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6479
Practice Address - Country:US
Practice Address - Phone:605-322-4919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA MCKENNAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care