Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Functional Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (CEO/PRESIDENT)
(605) 322-8000
Entity
Organization
Contact information
Practice address
911 E 20TH ST, STE 200, SIOUX FALLS, SD 57105-1042
(605) 322-3455
(605) 322-3456
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007280
BCBS
SD
05
—
0748939
—
IA
05
—
10025120100
—
NE
01
—
370624200
DEPT OF LABOR
SD
01
—
67B25MI
BLUE PLUS
MN
01
—
74474
HEALTHPARTNERS
SD
05
—
775790500
—
MN
01
—
9177384
DAKOTACARE
SD
Enumeration date
02/27/2006
Last updated
02/16/2021
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