AVERA MCKENNAN (NPI# 1386793776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386793776 |
| Entity Type | Organization |
| Organization Name | AVERA MCKENNAN |
| Other Organization Name | AVERA MEDICAL GROUP COLTON |
| Practice Address |
300 S. Sherman Colton SD 57018 |
| Mailing Address |
Po Box 9 300 S. Sherman Colton SD 57018 |
| Practice Telephone | 6054463233 |
| Mailing Telephone | 6054463233 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2011-03-21 |
| Authorized Official Name | JULIE N. NORTON (SENIOR VICE PRESIDENT FINANCE) |
| Authorized Official Telephone | 6053226375 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 5214 | SD | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 3570 | SD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | 5611472 | 05 | |
| SD | 5609026 | 05 |
| Other Name | Type Code |
|---|---|
| Avera Medical Group Colton | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154979805 | Avera Mckennan | Substance Abuse Rehabilitation Facility | 6140 S Curae Lane, Sioux Falls, SD 57108-3047 | 2019-08-27 |
| 1205311628 | Avera Mckennan | Pharmacy | 6100 S Louise Ave Ste 1100, Sioux Falls, SD 57108-6021 | 2018-10-02 |
| 1316463219 | Avera Mckennan | Pharmacy | 1200 S. 7th Avenue, Suite 101, Sioux Falls, SD 57105 | 2017-08-22 |
| 1851848444 | Avera Mckennan | Durable Medical Equipment & Medical Supplies | 2100 S Marion Road, Ste 125, Sioux Falls, SD 57106-3645 | 2016-09-01 |
| 1295187417 | Avera Mckennan | Psychiatry & Neurology | 6709 S. Minnesota Ave., Ste. 103, Sioux Falls, SD 57108-2593 | 2016-07-12 |
| 1669871000 | Avera Mckennan | Durable Medical Equipment & Medical Supplies | 3820 N Potsdam Ave Ste 2, Sioux Falls, SD 57104-7057 | 2014-08-21 |
| 1922413806 | Avera Mckennan | Clinic/Center | 400 2nd Ave, Brookings, SD 57006 | 2014-06-30 |
| 1629499132 | Avera Mckennan | Occupational Therapist | 1601 W 44th Pl, Sioux Falls, SD 57105-6376 | 2013-12-31 |
| 1700146396 | Avera Mckennan | Clinic/Center | 1035 South Highline Pl, Ste #4, Sioux Falls, SD 57110 | 2012-05-17 |
| 1467711739 | Avera Mckennan | Pharmacy | 1301 S Cliff Ave Ste 225, Sioux Falls, SD 57105-1068 | 2012-05-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | AVERA MCKENNAN | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 |
| Iowa Business Entities | AVERA MCKENNAN | 1325 S. Cliff St., Sioux Falls, SD 57105 |
| System for Award Management (SAM) Entities | AVERA MCKENNAN HOSPITAL & UNIVERSITY HEALTH CENTER | 1325 S Cliff Ave, Sioux Falls, SD 57105-1007 |
| Street Address |
300 S. SHERMAN |
| City | COLTON |
| State | SD |
| Zip Code | 57018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427245661 | Holly Jo Hodge | Occupational Therapy Assistant | 309 S Glenn Ave, Colton, SD 57018-2108 | 2007-10-02 |
| 1578514675 | Ward Enterprises, LLP | Assisted Living Facility | 706 E 1st St, Colton, SD 57018-2137 | 2006-05-13 |
| 1538656798 | Colton Retirement Living, Inc | Assisted Living Facility | 706 E 1st St, Colton, SD 57018-2137 | 2018-04-13 |
| 1578757142 | Glamme Systems, Inc | Durable Medical Equipment & Medical Supplies | 24557 456th Ave, Colton, SD 57018-5037 | 2007-08-28 |
| 1497186183 | Shelly Grinde | Speech-Language Pathologist | 24648 463rd Ave, Colton, SD 57018-5163 | 2013-12-05 |
| 1417170697 | Tri-valley School District | Local Education Agency (LEA) | 46450 252nd St, Colton, SD 57018-5712 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669071882 | Gerardo Quinones Sr. | Technician, Pathology | 839 Illinois Ave., Colton, CA 92324-9232 | 2020-10-19 |
| 1053910273 | Onsite Phlebotomy Solutions | Clinical Medical Laboratory | 1040 S Mount Vernon Ave # G-276, Colton, CA 92324-4228 | 2020-10-19 |
| 1255939690 | Christopher Vaughn | Massage Therapist | 1113 N 7th St Apt B, Colton, CA 92324-2467 | 2020-10-16 |
| 1558969048 | Myoshi Fraise | Behavior Technician | 2170 N Rancho Ave Apt H236, Colton, CA 92324-6941 | 2020-10-15 |
| 1487252631 | Daniel Aguirre | Massage Therapist | 901 E Washington St Apt 462, Colton, CA 92324-8149 | 2020-10-10 |
| 1063019503 | Traci Julia Richardson | Massage Therapist | 1316 S Meadow Ln Apt 161, Colton, CA 92324-6411 | 2020-10-07 |
| 1083211155 | Krystal Marie Lopez | Dietitian, Registered | 4000 N Peppr Ave., Colton, CA 92323 | 2020-10-02 |
| 1407463904 | Adrianna Silva | Massage Therapist | 823 Walnut St, Colton, CA 92324-3320 | 2020-09-28 |
| 1720694524 | Lateisha Mcdonald | Registered Nurse | 1003 E Cooley Dr Ste J, Colton, CA 92324-3948 | 2020-09-17 |
| 1629683552 | Attentive Care Hospice Inc | Hospice Care, Community Based | 1003 E Cooley Dr Ste B, Colton, CA 92324-3948 | 2020-09-08 |
| Find all providers in COLTON | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063897 | Inland Empire Medical Group Inc. | Family Medicine | 1550 E Washington St # 101, Colton, CA 92324-4624 | 2019-10-03 |
| 1033473293 | Tawfikul Alam | Family Medicine | 400 N Pepper Ave Ste 204, Colton, CA 92324-1801 | 2012-07-02 |
| 1043504004 | Heather Bohn | Family Medicine | 400 N Pepper, Colton, CA 92324 | 2011-06-07 |
| 1477844017 | Brenda Lynn Rea | Family Medicine | 2112 Harris St, Colton, CA 92324-7523 | 2011-05-01 |
| 1528393535 | Ryan James Cabatbat | Family Medicine | 1699 E Washington St Apt 2016, Colton, CA 92324-4673 | 2009-10-08 |
| 1194992073 | Janette Marie Brunken | Family Medicine | 1981 Fig Tree Rd, Colton, CA 92324-8464 | 2008-05-10 |
| 1881805745 | Harpreet Singh | Family Medicine | 1300 East Cooley Drive, Colton, CA 92234-3905 | 2007-05-24 |
| 1871627307 | Sara Bigdeli | Family Medicine | 789 E Cooley Dr, Colton, CA 92324-4007 | 2007-03-15 |
| 1114032448 | Molina Medical Centers | Family Medicine | 1001 E Cooley Dr Ste 106, Colton, CA 92324-3941 | 2006-08-19 |
| 1104858059 | James Evans | Family Medicine | Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA 92324-9999 | 2006-07-07 |
| Find all providers in COLTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.