Organization
AVERA MCKENNAN
Active
Parent organization
AVERA MCKENNAN
Other names
Avera Medical Group Worthington
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVERA MCKENNAN
Authorized official
KELLI VAN GROUW (CLINIC MANAGER)
(507) 372-2921
Entity
Organization
Contact information
Practice address
1216 RYANS RD, WORTHINGTON, MN 56187-1722
(507) 372-2921
(507) 372-5789
Mailing address
1216 RYANS RD, WORTHINGTON, MN 56187-1722
(507) 372-2921
(507) 372-5789
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48941WO
BCBS
MN
01
—
690009299
RAILROAD MEDICARE
MN
05
—
951015000
—
MN
Enumeration date
01/15/2008
Last updated
04/01/2013
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