Avera Medical Group Wilmot

LBN: Avera Mckennan
Avera Medical Group Wilmot is an health care organization with primary practice located at 409 4Th St , Wilmot SD 57279-2214. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Rural Health, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Ambulatory Health Care Facilities / Rural Health is the primary health care specialty. Avera Mckennan can be contacted via phone (605) 938-4351, or through Flicek, David via phone (605) 322-7916.

Contact Information

Primary practice address
409 4Th St Wilmot SD 57279-2214
Phone: (605) 938-4351
Fax: (605) 938-4351
Website:
Map and Directions
Authorized official contact:
Name: Flicek, David
Phone: (605) 322-7916

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X

Profile Details

NPI number 1770680787
LBN Legal business name Avera Mckennan
DBA Doing business as Avera Medical Group Wilmot
Authorized official Flicek, David
Entity Organization
Organization subpart 1 No
Enumeration date Sep 20th, 2006
Last updated Sep 10th, 2020 - 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 1770680787 NPPES
South Dakota MEDICAID 5300010
South Dakota Other 43D0901649

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