Organization
AVERA MCKENNAN
Active
Other names
Avera Dialysis Brookings
Organization subpart
No
Provider details
NPI number
Authorized official
DAIVD FLICEK (PRESIDENT/CEO)
(605) 322-7915
Entity
Organization
Contact information
Practice address
300 22ND AVE, SUITE 101, BROOKINGS, SD 57006-2480
(605) 696-7760
(605) 696-7765
Mailing address
PO BOX 5045, ATTN: P.F.S PROV ENROLLMENT, SIOUX FALLS, SD 57117-5045
(605) 322-6428
(605) 322-6499
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
10563
SD
Other
Enumeration date
05/21/2012
Last updated
07/01/2021
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