Avera Medical Group Waubay | |
80 N Main St Waubay SD 57273 | |
(605) 947-4322 | |
(605) 947-3423 |
Full Name | Avera Medical Group Waubay |
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Speciality | Clinic/Center |
Location | 80 N Main St, Waubay, South Dakota |
Authorized Official Name and Position | David Flicek (PRESIDENT/CEO) |
Authorized Official Contact | 6053227916 |
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 Waubay 80 N Main St Po Box 215 Waubay SD 57273 Ph: (605) 947-4322 | Avera Medical Group Waubay 80 N Main St Waubay SD 57273 Ph: (605) 947-4322 |
NPI Number | 1427003946 |
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Provider Enumeration Date | 05/23/2006 |
Last Update Date | 09/10/2020 |
Medicare PECOS PAC ID | 0345157103 |
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Medicare Enrollment ID | O20100423000491 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427003946 | NPI | - | NPPES |
5300800 | Medicaid | SD | |
43D0974942 | Other | CLIA # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | 0317 (South Dakota) | Secondary |