Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Larchwood
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE N NORTON (SR VICE PRESIDENT OF FINANCE)
(605) 322-6375
Entity
Organization
Contact information
Practice address
916 HOLDER ST, LARCHWOOD, IA 51241-0008
(712) 477-2185
(712) 477-2186
Mailing address
PO BOX 86430, SIOUX FALLS, SD 57118-6430
(605) 322-4900
(605) 322-4910
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0425074
—
IA
05
—
2900993
—
IA
Enumeration date
07/10/2006
Last updated
05/16/2012
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