Avera McKennan
Organization Active NPI Physical Therapy Clinic/Center · Brandon, SD
NPI 1346494697 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1346494697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 10563 (SD)
- Legal business name
- AVERA MCKENNAN
- Practice address
- 103 N Splitrock Blvd
Brandon, SD 57005-1529 - Phone
- (605) 582-3908
- Fax
- (605) 582-3349
- NPI assigned
- Nov 13, 2008
- Organization subpart
- No
Authorized official
- Name
- Ronald Joseph Place, MD
- Title
- President/Ceo
- Phone
- (605) 322-7903
Corporate family (same tax ID) 24
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
- Tax ID family
- Avera McKennan Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 10563 | SD | Yes |
Addresses
Primary practice location
103 N Splitrock Blvd
Brandon, SD 57005-1529
Mailing address
PO Box 5045
Attn: Provider Enrollment PT Financial Services
Sioux Falls, SD 57117-5045
Phone (605) 322-6428
Other names
- Avera McKennan Outpatient Therapy Services - Brandon
Other providers in Brandon, SD
- Macy Archer
- Ascend Counseling, LLC
- Aspire Counseling & Consulting, LLC
- Authentic Counseling LLC
- Avera McKennan
- Kara Lynn Baas
- Kyle Babb
- Jessica Ann Bebensee
- Bethany Lutheran Home
- Bethany Lutheran Home for the Aged Inc.
All providers in Brandon, SD · Physical Therapy Clinic/Center 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 4, 2023. 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.