Organization
AVERA MCKENNAN
Active
Other names
Avera Neurosurgery - Daniel G. Tynan, M.D.
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 600, SIOUX FALLS, SD 57105-1020
(605) 322-4800
(605) 322-4801
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
4653
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025595900
—
NE
01
—
4992604
BLUE CROSS/SD
SD
01
—
6I362AV
BLUE PLUS
MN
01
—
9251035
DAKOTACARE
SD
Enumeration date
08/07/2007
Last updated
03/30/2010
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