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Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera Prince of Peace Outpatient Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (PRESIDENT)
(605) 322-7915
Entity
Organization
Contact information
Practice address
4513 S PRINCE OF PEACE PL STE 1, SIOUX FALLS, SD 57103-5830
(605) 322-5618
Mailing address
800 E 21ST ST, PO BOX 5045, PROV ENROLLMENT, SIOUX FALLS, SD 57105-1016
(605) 322-6400
(605) 322-6499
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
10563
SD
Other
Enumeration date
09/22/2009
Last updated
07/01/2021
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