Organization
AVERA MCKENNAN
Active
Other names
AVERA MEDICAL GROUP WAUBAY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (PRESIDENT/CEO)
(605) 322-7916
Entity
Organization
Contact information
Practice address
80 N MAIN ST, WAUBAY, SD 57273
(605) 947-4322
(605) 947-3423
Mailing address
80 N MAIN ST, PO BOX 215, WAUBAY, SD 57273
(605) 947-4322
(605) 947-3423
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
0317
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43D0974942
CLIA #
—
05
—
5300800
—
SD
Enumeration date
05/23/2006
Last updated
09/10/2020
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