MEDICARE: AVERA MCKENNAN

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	370624200	OTHER	SD	DEPT OF LABOR
3	396S9MI	OTHER	MN	BLUE PLUS
4	9202239	OTHER	SD	DAKOTACARE
5	040122003	OTHER	MN	PRIMEWEST
6	83986	OTHER	SD	HEALTHPARTNERS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0040219	OTHER	SD	BCBS
9	396S9MI	OTHER	MN	BCBS

NPI Number	:	1346216074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	6701 S MINNESOTA AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2591
Country	:	US
Telephone Number	:	605-322-6960
Fax Number	:	605-322-6961

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DAVID FLICEK
Credential	:
Telephone Number	:	605-322-8000

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/31/2020

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

6701 S MINNESOTA AVE
SIOUX FALLS, SD
57108-2591