Avera McKennan
Organization Active NPI Psychiatry Physician · Sioux Falls, SD
NPI 1760933261 · NPPES record last updated Oct 24, 2018
Key facts
- NPI
- 1760933261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- AVERA MCKENNAN
- Practice address
- 2412 S Cliff Ave
Ste 200
Sioux Falls, SD 57105-4031 - Phone
- (605) 322-4079
- Fax
- (605) 322-4080
- NPI assigned
- Oct 19, 2016
- Organization subpart
- No
Authorized official
- Name
- David Flicek
- Title
- Ceo/President
- Phone
- (605) 322-8000
Corporate family (same tax ID) 24
Practitioners 21
-
Joann M Adney, MSW LCSW PIP
-
Collin Jansen Block, MSW
-
Mary Beth Dornheim, LICSW
-
Tonya Cole Ellingson, FNP
-
Wade Hauglid, LCSW-PIP, LAC
-
Malia Holbeck, CSW
-
Chinedu Izuchi, CNP
-
Theresa Michelle Newcomb, APRN-NP
-
Melissa Sue Roby, LPC
-
Linda Rush, MS, LPC, CCDCIII
-
Dawn Laureen Agnes Soulek, LCSW-PIP
-
Virginia Strubbe, LCSW
-
Tori Sarah Thaler, LCSW-PIP, LISW
-
Connie Denise Graber, PSY.D.
-
Lawrence August Ling, LCSW
-
Else Munsterteiger, LSW, ADS
-
Jennifer Stratton, MA LPCC MA LADC
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
Locations
1301 S Cliff Ave
Ste 506
Sioux Falls, SD 57105
Phone (605) 335-0844
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
2412 S Cliff Ave
Ste 200
Sioux Falls, SD 57105-4031
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-4995
Other names
- Avera Medical Group Behavioral Health Clinic
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 · Psychiatry 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 24, 2018. 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.