AVERA MCKENNAN NPI 1427090760

NPI Information

NPI: 1427090760
Provider Name: AVERA MCKENNAN
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
:
CLIA Number: 43D1032895
Address: 110 S LOGAN AVE STE A
GREGORY, SD
ZIP 57533
Phone: (605) 835-9611

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NPI Details

AVERA MCKENNAN is a clinic center in Gregory, SD. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). AVERA MCKENNAN NPI is 1427090760. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

110 S LOGAN AVE STE A
GREGORY, SD
ZIP 57533-614
Phone: (605) 835-9611
Fax: (605) 835-8033

The provider's authorized official is David William Flicek .
The authorized official title is President/ceo and has the following contact phone number (605) 322-7915.

The CLIA number assigned to this NPI record is 43D1032895 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/12/2006 and was last updated on 11/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	261Q00000X	Clinic/Center				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	46011474312	MEDICAID	NEBRASKA
2	0000028	OTHER	SOUTH DAKOTA	WELLMARK BC/BS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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