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General NPI Number Information
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NPI Number | 1316601743
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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 | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 1417 S CLIFF AVE STE 300
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1062
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Country | US
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Telephone | 605-504-3000
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Fax | 605-504-3001
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Provider Business Mailing Address
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Address Line | 1417 S CLIFF AVE STE 300
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1062
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Country | US
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Telephone | 605-504-3000
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Fax | 605-504-3001
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DAVID WILLIAM FLICEK
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Credential |
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Telephone | 605-322-7915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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