Avera McKennan
Organization Active NPI Family Medicine Physician · Spencer, IA
NPI 1902886567 · NPPES record last updated Mar 12, 2012
Key facts
- NPI
- 1902886567
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AVERA MCKENNAN
- Practice address
- 116 E 11TH St
Suite 101
Spencer, IA 51301-4364 - Phone
- (712) 264-3500
- Fax
- (712) 264-3535
- NPI assigned
- Jan 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Julie N Norton
- Title
- V.P. Finance
- Phone
- (605) 322-6375
Other NPIs on the same Medicare enrollment 25
Member of 1
Practitioners 54
-
Gregory Jay Kosters, D.O.
-
David Paul Robison, D.O.
-
Julia Agnes Abraham, PA-C
-
Kathryn Ann Adams, CNP
-
Sami M Awadallah, M.D.
-
Connie Belford, C.N.P.
-
Samantha Lee Bonn, LCSW
-
Stephanie Bork, CNP
-
Danielle Campbell, FNP
-
Teresa M Cass, CPNP
-
Julie Ann Cox, CNP
-
Justin Michael Gabbert, PA-C
-
Nicole Gibson, DNP
-
Kimberly Haines, CNP
-
Jamie Alyssa Hillmer, CNP
-
Kelsey Marie Hupp, FNP-C
-
Teresa Ann Jatczak, CNP
-
Tiera Lamb, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000384 | IA | Part B Supplier - Clinic/Group Practice | 0345157103 |
Receives reassigned benefits from 91 practitioners 25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rock Valley, IA; Spirit Lake, IA; Spencer, IA; Sioux Center, IA; Sibley, IA; Rock Rapids, IA; Milford, IA; Mason City, IA… |
National Provider Directory
Locations
301 Flynn Dr
Milbank, SD 57252
Phone (605) 432-4587
900 E Church St
Pierre, SD 57501
6701 S Minnesota Ave
Sioux Falls, SD 57108
Phone (605) 322-6960
1417 S Cliff Ave
Sioux Falls, SD 57105
Phone (605) 322-3477
2412 S Cliff Ave
Ste 200
Sioux Falls, SD 57105
Phone (605) 322-4079
6100 S Louise Ave
Ste 3100
Sioux Falls, SD 57108
Phone (605) 322-8630
1910 W 69th St
Ste 2
Sioux Falls, SD 57108
Phone (605) 322-5285
911 E 20th St
Ste 300
Sioux Falls, SD 57105
Phone (605) 322-1300
2100 S Marion Rd
Ste 315
Sioux Falls, SD 57106
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | IA | Yes | |
| Physician Assistant |
363A00000X | IA | ||
| Family Nurse Practitioner |
363LF0000X | IA | ||
| Pediatric Nurse Practitioner |
363LP0200X | IA |
Addresses
Primary practice location
116 E 11TH St
Suite 101
Spencer, IA 51301-4364
Mailing address
116 E 11TH St
Suite 101
Spencer, IA 51301-4364
Phone (712) 264-3500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0252791 | Medicaid | IA |
Other names
- Avera Medical Group Spencer
Other providers in Spencer, IA
- Robert Appel
- Applewhite Dental Iowa PC
- Benjamin John Armstrong
- Laura Ann Armstrong
- Avera Home Medical Equipment of Spencer Hospital LLC
- Doreen C Baerentzen
- Sheri Ann Baker
- Robert Matthew Baltes
- Dominique Baugh
- Noah Becker
All providers in Spencer, IA · Family Medicine Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2012. 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.