Avera Medical Group Gregory

LBN: Avera Mckennan
Avera Medical Group Gregory is an health care organization with primary practice located at 110 S Logan Ave Ste A , Gregory SD 57533-1614. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Suppliers / Durable Medical Equipment & Medical Supplies. Ambulatory Health Care Facilities / Clinic/Center is the primary health care specialty. Avera Mckennan can be contacted via phone (605) 835-9611, or through Flicek, David William via phone (605) 322-7915.

Contact Information

Primary practice address
110 S Logan Ave Ste A Gregory SD 57533-1614
Phone: (605) 835-9611
Fax: (605) 835-8033
Website:
Map and Directions
Authorized official contact:
Name: Flicek, David William
Phone: (605) 322-7915

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X

Profile Details

NPI number 1427090760
LBN Legal business name Avera Mckennan
DBA Doing business as Avera Medical Group Gregory
Authorized official Flicek, David William
Entity Organization
Organization subpart 1 No
Enumeration date Jun 12th, 2006
Last updated Feb 10th, 2023 - about 2 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 1427090760 NPPES
Nebraska MEDICAID 46011474312
Nebraska Other 0000028

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