# AVERA MCKENNAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avera Medical Group Fairfax
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215967203
- **Authorized official:** JULIE N NORTON (VICE PRESIDENT OF FINANCE)
- **Authorized official phone:** (605) 322-6375

## Contact information

- **Practice address:** 421 MAIN ST, FAIRFAX, SD 57335-0354
- **Practice address phone:** (605) 654-2366
- **Mailing address:** PO BOX 354, 421 MAIN, FAIRFAX, SD 57335-0354
- **Mailing address phone:** (605) 654-2366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 03/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000028 | WELLMARK BC/BS | SD |