Avera Medical Group Gregory | |
110 S Logan Ave Ste A Gregory SD 57533-1614 | |
(605) 835-9611 | |
(605) 835-8033 |
Full Name | Avera Medical Group Gregory |
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Speciality | Clinic/Center |
Location | 110 S Logan Ave Ste A, Gregory, South Dakota |
Authorized Official Name and Position | David William Flicek (PRESIDENT/CEO) |
Authorized Official Contact | 6053227915 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Avera Medical Group Gregory 405 Whittecar Ave Gregory SD 57533-1340 Ph: (605) 835-9611 | Avera Medical Group Gregory 110 S Logan Ave Ste A Gregory SD 57533-1614 Ph: (605) 835-9611 |
NPI Number | 1427090760 |
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Provider Enumeration Date | 06/12/2006 |
Last Update Date | 02/10/2023 |
Medicare PECOS PAC ID | 0345157103 |
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Medicare Enrollment ID | O20100930015567 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427090760 | NPI | - | NPPES |
46011474312 | Medicaid | NE | |
0000028 | Other | SD | WELLMARK BC/BS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |