# AVERA MCKENNAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avera Prince of Peace Outpatient Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467786640
- **Authorized official:** DAVID FLICEK (PRESIDENT)
- **Authorized official phone:** (605) 322-7915

## Contact information

- **Practice address:** 4513 S PRINCE OF PEACE PL STE 1, SIOUX FALLS, SD 57103-5830
- **Practice address phone:** (605) 322-5618
- **Mailing address:** 800 E 21ST ST, PO BOX 5045, PROV ENROLLMENT, SIOUX FALLS, SD 57105-1016
- **Mailing address phone:** (605) 322-6400
- **Mailing address fax:** (605) 322-6499

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 10563 | SD | Yes |

## Other

- **Enumeration date:** 09/22/2009
- **Last updated:** 07/01/2021