Organization
AVERA MCKENNAN
Active
Other names
Avera Prince of Peace Outpatient Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (PRESIDENT)
(605) 322-7915
Entity
Organization
Contact information
Practice address
4513 S PRINCE OF PEACE PL STE 1, SIOUX FALLS, SD 57103-5830
(605) 322-5618
Mailing address
800 E 21ST ST, PO BOX 5045, PROV ENROLLMENT, SIOUX FALLS, SD 57105-1016
(605) 322-6400
(605) 322-6499
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
10563
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025846600 (PT )
—
NE
05
—
10025846700 (OT GRP)
—
NE
05
—
1467786640
—
IA
05
—
1467786640
—
MN
01
—
9290262
DAKOTACARE
SD
Enumeration date
09/22/2009
Last updated
07/01/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up