Avera Medical Group Functional Medicine
LBN: Avera Mckennan
Avera Medical Group Functional Medicine is an health care organization with primary practice located at 911 E 20Th St Ste 200, Sioux Falls SD 57105-1042. The organization recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Women's Health, which is considered as the primary health care specialty.
Avera Mckennan can be contacted via phone (605) 322-3455, or through Flicek, David via phone (605) 322-8000.
Contact Information
Primary practice address
911 E 20Th St Ste 200
Sioux Falls SD 57105-1042
Phone: (605) 322-3455
Fax: (605) 322-3456
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Women's Health | 363LW0102X |
Profile Details
| NPI number | 1255307450 |
|---|---|
| LBN Legal business name | Avera Mckennan |
| DBA Doing business as | Avera Medical Group Functional Medicine |
| Authorized official | Flicek, David |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 27th, 2006 |
| Last updated | Feb 16th, 2021 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255307450 | NPPES |
| South Dakota | Other | 370624200 | DEPT OF LABOR |
| South Dakota | Other | 67B25MI | DEPT OF LABOR |
| South Dakota | Other | 67B25MI | DEPT OF LABOR |
| South Dakota | Other | 9177384 | DEPT OF LABOR |
| South Dakota | Other | 0007280 | DEPT OF LABOR |
| South Dakota | MEDICAID | 10025120100 | DEPT OF LABOR |
| South Dakota | Other | 74474 | DEPT OF LABOR |
| South Dakota | MEDICAID | 0748939 | DEPT OF LABOR |
| South Dakota | MEDICAID | 775790500 | DEPT OF LABOR |
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