Organization
AVERA MCKENNAN
Active
Parent organization
AVERA MCKENNAN
Other names
Avera Medical Group Windom
Organization subpart
Yes
Provider details
NPI number
Legal business name
AVERA MCKENNAN
Authorized official
DAVID WILLIAM FLICEK (PRESIDENT/CEO)
(605) 322-7915
Entity
Organization
Contact information
Practice address
2020 HOSPITAL DR., STE. 2, WINDOM, MN 56101-1766
(507) 831-1703
(507) 831-5668
Mailing address
800 E 21ST STREET, PO BOX5045, SIOUX FALLS, SD 57117-5045
(605) 322-6375
(605) 322-6363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433903700
—
MN
01
—
C18643
RAILROAD MEDICARE
—
Enumeration date
09/22/2006
Last updated
06/10/2021
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