National Provider Identifier Database

AVERA MCKENNAN
Primary Care


Contact Information

AVERA MCKENNAN
916 HOLDER ST
LARCHWOOD, IA51241-0008
Phone: 712-477-2185
Fax: 712-477-2186
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for AVERA MCKENNAN

NPI Number 1871527507
Legal business name
LBN
AVERA MCKENNAN
Authorized official JULIE NORTON - (SR VICE PRESIDENT OF FINANCE)
Entity Organization
Organization subpart No
Enumeration date 07/10/2006
Last updated 05/16/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • IA Medicaid: 0425074
  • IA Medicaid: 2900993

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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