Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Midwest Psychiatric Medicine Sioux Falls
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (CEO/PRESIDENT)
(605) 322-8000
Entity
Organization
Contact information
Practice address
4400 W 69TH ST, STE 500, SIOUX FALLS, SD 57108
(605) 322-7580
(605) 322-7579
Mailing address
PO BOX 86370, SIOUX FALLS, SD 57118-6370
(605) 322-7510
(605) 322-6475
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006118
BCBS
SD
05
—
0211607
—
IA
05
—
293011100
—
MN
01
—
370624200
DEPT OF LABOR
SD
01
—
3T021SC
BLUE PLUS
MN
01
—
65742
HEALTHPARTNERS
SD
01
—
92411422904
PRIMEWEST
SD
Enumeration date
02/08/2006
Last updated
10/24/2018
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