# AVERA MCKENNAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avera Medical Group Gregory
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427090760
- **Authorized official:** DAVID WILLIAM FLICEK (PRESIDENT/CEO)
- **Authorized official phone:** (605) 322-7915

## Contact information

- **Practice address:** 110 S LOGAN AVE STE A, GREGORY, SD 57533-1614
- **Practice address phone:** (605) 835-9611
- **Practice address fax:** (605) 835-8033
- **Mailing address:** 110 S LOGAN AVE STE A, GREGORY, SD 57533-1614
- **Mailing address phone:** (605) 835-9611
- **Mailing address fax:** (605) 835-8033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 11/17/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000028 | WELLMARK BC/BS | SD |
| 05 | — | 46011474312 | — | NE |