Avera Medical Group Revillo

LBN: Avera Mckennan
Avera Medical Group Revillo is an health care organization with primary practice located at 305 N 2Nd Ave , Revillo SD 57259-0006. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Avera Mckennan can be contacted via phone (605) 623-4695, or through Flicek, David via phone (605) 322-7915.

Contact Information

Primary practice address
305 N 2Nd Ave Revillo SD 57259-0006
Phone: (605) 623-4695
Fax: (605) 623-4318
Website:
Map and Directions
Authorized official contact:
Name: Flicek, David
Phone: (605) 322-7915

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X South Dakota

Profile Details

NPI number 1588677892
LBN Legal business name Avera Mckennan
DBA Doing business as Avera Medical Group Revillo
Authorized official Flicek, David
Entity Organization
Organization subpart 1 No
Enumeration date Aug 15th, 2006
Last updated Jul 2nd, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588677892 NPPES
South Dakota Other 4996359 SD BLUE CROSS-REVILLO P#
South Dakota MEDICAID 246933200 SD BLUE CROSS-REVILLO P#
South Dakota Other 9204609 SD BLUE CROSS-REVILLO P#
South Dakota Other 228L6RE SD BLUE CROSS-REVILLO P#
South Dakota MEDICAID 5800490 SD BLUE CROSS-REVILLO P#

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