Organization
AVERA MCKENNAN
Active
Other names
Avera McKennan Regional Lab
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (PRESIDENT/CEO)
(605) 322-7916
Entity
Organization
Contact information
Practice address
1301 S CLIFF AVE, REGIONAL LAB, SIOUX FALLS, SD 57105-1005
(605) 322-7187
(605) 322-7183
Mailing address
PO BOX 5045, ATTN: P.F.S., SIOUX FALLS, SD 57117-5045
(605) 322-7187
(605) 322-7183
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
43D0658878
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0569285
—
IA
01
—
1034593
PREFERRED ONE
SD
01
—
165L6AV
BLUE CROSS OF MINNESOTA
MN
01
—
4995742
BLUE CROSS OF SD
SD
05
—
5580610
—
SD
01
—
604999
ARAZ
SD
01
—
F230764
MIDLANDS CHOICE
SD
Enumeration date
07/26/2006
Last updated
11/12/2020
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