Organization
AVERA MCKENNAN
Active
Other names
Avera Neurosurgery - Mark W. Fox, M.D., FACS
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE N NORTON (SENIOR VP OF FINANCE)
(605) 322-6375
Entity
Organization
Contact information
Practice address
1100 E 21ST ST, STE 220, SIOUX FALLS, SD 57105-1020
(605) 322-4825
(605) 322-4826
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
4319
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025562500
—
NE
01
—
167004
HEALTHPARTNERS
SD
01
—
46L93AV
BLUE PLUS
MN
01
—
9251034
DAKOTACARE
SD
Enumeration date
08/20/2007
Last updated
03/12/2012
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