Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Health Care Clinic Sioux Falls
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (CEO/PRESIDENT)
(605) 322-8000
Entity
Organization
Contact information
Practice address
300 N DAKOTA AVE., STE. 117, SIOUX FALLS, SD 57104-6020
(605) 322-6800
(605) 322-6802
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006020
BLUE CROSS OF SOUTH DAKOT
SD
05
—
0532341
—
IA
05
—
068417100
—
MN
05
—
12262
—
ND
01
—
30B74GU
BLUE CROSS
MN
01
—
30B74GU
BLUE PLUS
SD
01
—
57105F001
TRICARE
SD
01
—
59767
HEALTHPARTNERS
SD
01
—
9251873
DAKOTACARE
SD
Enumeration date
11/07/2007
Last updated
10/24/2018
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