| Avera Mckennan | |
|
305 N 2nd Ave Revillo SD 57259-0006 | |
| (605) 623-4695 | |
| (605) 623-4318 |
| Full Name | Avera Mckennan |
|---|---|
| Speciality | Clinic/Center |
| Location | 305 N 2nd Ave, Revillo, South Dakota |
| Authorized Official Name and Position | David 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 901 E Virgil Ave Milbank SD 57252-2124 Ph: (605) 432-4538 | Avera Mckennan 305 N 2nd Ave Revillo SD 57259-0006 Ph: (605) 623-4695 |
| NPI Number | 1588677892 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 07/02/2021 |
| Medicare PECOS PAC ID | 0345157103 |
|---|---|
| Medicare Enrollment ID | O20020918000017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588677892 | NPI | - | NPPES |
| 4996359 | Other | SD | SD BLUE CROSS-REVILLO P# |
| 246933200 | Medicaid | MN | |
| 9204609 | Other | SD | DAKOTACARE REVILLO PROV# |
| 228L6RE | Other | MN | MN BLUE CROSS-REVILLO P# |
| 5800490 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (South Dakota) | Primary |