NPIMap

Organization Active NPI

Avera McKennan

  • Family Medicine Physician
  • Colton, SD
National Provider Identifier
1386793776
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3570 Issued in SD
Legal business name
AVERA MCKENNAN
Practice address
300 S. Sherman
Colton, SD 57018
Phone
(605) 446-3233
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Julie N. Norton
Title
Senior Vice President Finance
Phone
(605) 322-6375

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 3570 SD Primary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 5214 SD

Addresses

Primary practice location

300 S. Sherman
Colton, SD 57018

Mailing address

PO Box 9
300 S. Sherman
Colton, SD 57018
Phone (605) 446-3233

Other identifiers 2

IdentifierTypeStateIssuer
5609026MedicaidSD
5611472MedicaidSD

Other names 1

  • Avera Medical Group Colton Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avera McKennan Hosp105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

300 S Sherman Ave
Colton, SD 57018
Phone (605) 446-3233

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1386793776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "address_2": "300 S. SHERMAN",
            "city": "COLTON",
            "state": "SD",
            "postal_code": "57018",
            "telephone_number": "605-446-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S. SHERMAN",
            "city": "COLTON",
            "state": "SD",
            "postal_code": "57018",
            "telephone_number": "605-446-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "NORTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "605-322-6375"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "3570",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "5214",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5609026",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5611472",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group Colton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colton, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.