Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Physical Medicine and Rehabilitation Sioux Falls
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (CEO/PRESIDENT)
(605) 322-8000
Entity
Organization
Contact information
Practice address
1301 S. CLIFF AVE., STE. 401, SIOUX FALLS, SD 57105-1053
(605) 322-7300
(605) 322-7301
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007817
BCBS
SD
05
—
0548487
—
IA
01
—
37624200
DEPT OF LABOR
SD
01
—
49D15RE
BCBS
MN
05
—
600045200
—
MN
01
—
77752
HP
SD
01
—
9177484
DC
SD
01
—
92411422907
PRIMEWEST
MN
Enumeration date
02/27/2006
Last updated
10/24/2018
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