Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera Dialysis Milbank
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FLICEK (PRESIDENT/CEO)
(605) 322-7915
Entity
Organization
Contact information
Practice address
301 FLYNN DR, STE 4, MILBANK, SD 57252-1508
(605) 432-3340
(605) 432-3344
Mailing address
PO BOX 5045, ATTN: PFS PROVIDER ENRLLMENT, SIOUX FALLS, SD 57117-5045
(605) 322-6428
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
10563
SD
Other
Enumeration date
03/01/2017
Last updated
07/01/2021
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