| Avera Mckennan | |
|
110 S Logan Ave Ste A Gregory SD 57533-1614 | |
| (605) 835-9611 | |
| (605) 835-8033 |
| Full Name | Avera Mckennan |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 S Logan Ave Ste A, Gregory, South Dakota |
| Authorized Official Name and Position | David William Flicek (PRESIDENT/CEO) |
| Authorized Official Contact | 6053227915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avera Mckennan 110 S Logan Ave Ste A Gregory SD 57533-1614 Ph: (605) 835-9611 | Avera Mckennan 110 S Logan Ave Ste A Gregory SD 57533-1614 Ph: (605) 835-9611 |
| NPI Number | 1427090760 |
|---|---|
| Provider Enumeration Date | 06/12/2006 |
| Last Update Date | 11/17/2025 |
| Medicare PECOS PAC ID | 0345157103 |
|---|---|
| Medicare Enrollment ID | O20100930015567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427090760 | NPI | - | NPPES |
| 46011474312 | Medicaid | NE | |
| 0000028 | Other | SD | WELLMARK BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |