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:
Map and Directions
Authorized official contact:
Name: Flicek, David
Phone: (605) 322-8000

Health care specialties

SpecialtyCodeLicense #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 3 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.

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Identifiers

StateTypeNumberIssuer
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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