| Avera Mckennan | |
|
80 N Main St Waubay SD 57273 | |
| (605) 947-4322 | |
| (605) 947-3423 |
| Full Name | Avera Mckennan |
|---|---|
| Speciality | Clinic/Center |
| Location | 80 N Main St, Waubay, South Dakota |
| Authorized Official Name and Position | David Flicek (PRESIDENT/CEO) |
| Authorized Official Contact | 6053227916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Avera Mckennan 80 N Main St Po Box 215 Waubay SD 57273 Ph: (605) 947-4322 | Avera Mckennan 80 N Main St Waubay SD 57273 Ph: (605) 947-4322 |
| NPI Number | 1427003946 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 0345157103 |
|---|---|
| Medicare Enrollment ID | O20100423000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427003946 | NPI | - | NPPES |
| 5300800 | Medicaid | SD | |
| 43D0974942 | Other | CLIA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | 0317 (South Dakota) | Secondary |