AVERA MCKENNAN NPI 1770680787

NPI Information

NPI: 1770680787
Provider Name: AVERA MCKENNAN
Classification: Clinic/Center - 261QR1300X
Specialization: Rural Health
Entity Type: Organization
Doing Business As: AVERA MEDICAL GROUP WILMOT
CLIA Number: 43D0901649
Address: 409 4TH ST
WILMOT, SD
ZIP 57279
Phone: (605) 938-4351

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NPI Details

AVERA MCKENNAN is a rural health clinic center in Wilmot, SD. AVERA MCKENNAN NPI is 1770680787. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Avera Medical Group Wilmot.

The provider's business location address is:

409 4TH ST
WILMOT, SD
ZIP 57279-214
Phone: (605) 938-4351
Fax: (605) 938-4351

The provider's authorized official is David Flicek .
The authorized official title is President/ceo and has the following contact phone number (605) 322-7916.

The CLIA number assigned to this NPI record is 43D0901649 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 9/10/2020.

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	363L00000X	Nurse Practitioner				No
2	261QR1300X	Clinic/Center	Rural Health			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	43D0901649	OTHER	SOUTH DAKOTA	CLIA #
2	5300010	MEDICAID	SOUTH DAKOTA

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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