Organization
AVERA MCKENNAN
Active
Other names
Avera Breast Center
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (PRESIDENT/CEO)
(605) 322-7916
Entity
Organization
Contact information
Practice address
1000 E 23RD ST, SUITE 330, SIOUX FALLS, SD 57105-2113
(605) 322-7465
(605) 322-1789
Mailing address
PO BOX 5045, ATTN: PT FINAN SERVICES, SIOUX FALLS, SD 57117-5045
(605) 322-6400
(605) 322-6499
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
10563
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025807100
—
NE
05
—
1467695767
—
IA
05
—
1467695767
—
MN
05
—
7290280
—
SD
01
—
9286132
DAKOTACARE
—
Enumeration date
04/16/2009
Last updated
01/08/2021
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