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General NPI Number Information
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NPI Number | 1083894067
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Entity Type | Organization
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Legal Business Name | AVERA MCKENNAN
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 300 N DAKOTA AVE. STE. 117
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City | SIOUX FALLS
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State | SD
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Zip | 57104-6020
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Country | US
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Telephone | 605-322-6800
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Fax | 605-322-6802
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Provider Business Mailing Address
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Address Line | PO BOX 86370
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City | SIOUX FALLS
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State | SD
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Zip | 57118-6370
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Country | US
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Telephone | 605-322-7510
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Fax | 605-322-6475
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DAVID FLICEK
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Credential |
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Telephone | 605-322-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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