| Avera Mckennan | |
|
4513 S Prince Of Peace Pl Ste 1 Sioux Falls SD 57103-5830 | |
| (605) 322-5618 | |
| Not Available |
| Full Name | Avera Mckennan |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4513 S Prince Of Peace Pl Ste 1, Sioux Falls, South Dakota |
| Authorized Official Name and Position | David Flicek (PRESIDENT) |
| Authorized Official Contact | 6053227915 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avera Mckennan 800 E 21st St Po Box 5045, Prov Enrollment Sioux Falls SD 57105-1016 Ph: (605) 322-6400 | Avera Mckennan 4513 S Prince Of Peace Pl Ste 1 Sioux Falls SD 57103-5830 Ph: (605) 322-5618 |
| NPI Number | 1467786640 |
|---|---|
| Provider Enumeration Date | 09/22/2009 |
| Last Update Date | 07/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467786640 | NPI | - | NPPES |
| 10025846700 (OT GRP) | Medicaid | NE | |
| 10025846600 (PT ) | Medicaid | NE | |
| 1467786640 | Medicaid | IA | |
| 1467786640 | Medicaid | MN | |
| 9290262 | Other | SD | DAKOTACARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 10563 (South Dakota) | Primary |
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