Avera McKennan
Organization Active NPI Otolaryngology Physician · Sioux Falls, SD
NPI 1316601743 · NPPES record last updated Oct 22, 2021
Key facts
- NPI
- 1316601743
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- Legal business name
- AVERA MCKENNAN
- Practice address
- 1417 S Cliff Ave Ste 300
Sioux Falls, SD 57105-1062 - Phone
- (605) 504-3000
- Fax
- (605) 504-3001
- NPI assigned
- Oct 22, 2021
- Organization subpart
- No
Authorized official
- Name
- David William Flicek
- Title
- President/Ceo
- Phone
- (605) 322-7915
Practitioners 13
-
Fawzi Mohammad Ameer, M.D.
-
Gustavo A Diaz, PA-C
-
Maren Patricia Ernst, CNP
-
Jason Dean Fowler, M.D., PH.D.
-
Kimberly Kay Lunder, PA-C
-
Amy Mundhenke, CNP
-
Ali Nazim, MD
-
Tammie V Smart, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000117 | SD | Part B Supplier - Clinic/Group Practice | 0345157103 |
Receives reassigned benefits from 1,418 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician |
207Y00000X | Yes |
Addresses
Primary practice location
1417 S Cliff Ave Ste 300
Sioux Falls, SD 57105-1062
Mailing address
1417 S Cliff Ave Ste 300
Sioux Falls, SD 57105-1062
Phone (605) 504-3000
Other names
- Avera Medical Group Ear, Nose & Throat
Other providers in Sioux Falls, SD
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
All providers in Sioux Falls, SD · Otolaryngology Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.