Avera McKennan
Organization Active NPI Long Term Care Pharmacy · Aberdeen, SD
NPI 1841948643 · NPPES record last updated Mar 11, 2022
Key facts
- NPI
- 1841948643
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- Legal business name
- AVERA MCKENNAN
- Practice address
- 815 1St Ave SE Ste 202
Aberdeen, SD 57401-4602 - Phone
- (605) 725-4001
- Fax
- (605) 725-2349
- NPI assigned
- Mar 11, 2022
- Organization subpart
- No
Authorized official
- Name
- David William Flicek
- Title
- President/Ceo
- Phone
- (605) 322-7915
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Avera Long Term Care Pharmacy Aberd |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Nebulizer Equipment and/or Supplies | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SD
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| Avera Heart Hospital of South Dakota |
Hospital | 5% Or Greater Direct Ownership Interest (33.33%) | Oct 1, 2010 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Oct 6, 1994 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2007 |
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| United Living Community |
Skilled nursing facility | Operational/Managerial Control | Nov 15, 2005 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081124000161 | SD | Part B Supplier - Mass Immunization (Roster Biller Only) | 0345157103 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Aberdeen, SD; Sioux Falls, SD |
| O20220719001500 | SD | DME Supplier - Pharmacy | 0345157103 | Practice locations: Aberdeen, SD |
National Provider Directory
- Tax ID family
- Avera McKennan Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Yes |
Addresses
Primary practice location
815 1St Ave SE Ste 202
Aberdeen, SD 57401-4602
Mailing address
815 1St Ave SE Ste 202
Aberdeen, SD 57401-4602
Phone (605) 725-4001
Other names
- Avera Long Term Care Pharmacy Aberdeen
Other providers in Aberdeen, SD
- Deptmer Martin Ashley
- Kevin James Aston
- Avera at Home
- Avera at Home
- Avera Home Medical Equipment, LLC
- Avera St Luke'S
- Avera St Luke'S
- Avera St Luke'S
- Avera St Luke'S
- Avera St Luke'S
All providers in Aberdeen, SD · Long Term Care Pharmacy 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 Mar 11, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.