Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Urogynecology Sioux Falls
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (CEO/PRESIDENT)
(605) 322-8000
Entity
Organization
Contact information
Practice address
6100 S LOUISE AVE STE 1110, SIOUX FALLS, SD 57108-6021
(605) 504-1570
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE0909
RR MEDICARE
SD
Enumeration date
02/03/2012
Last updated
11/01/2019
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