| Avera Medical Group Wilmot | |
|
409 4th St Wilmot SD 57279-2214 | |
| (605) 938-4351 | |
| (605) 938-4351 |
| Full Name | Avera Medical Group Wilmot |
|---|---|
| Speciality | Clinic/Center |
| Location | 409 4th St, Wilmot, 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 |
|---|---|
| Avera Medical Group Wilmot 409 4th St Wilmot SD 57279-2214 Ph: (605) 938-4351 | Avera Medical Group Wilmot 409 4th St Wilmot SD 57279-2214 Ph: (605) 938-4351 |
| NPI Number | 1770680787 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 0345157103 |
|---|---|
| Medicare Enrollment ID | O20100423000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770680787 | NPI | - | NPPES |
| 5300010 | Medicaid | SD | |
| 43D0901649 | Other | SD | CLIA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
Couteau Des Priaires Hospital & Clinic Wilmot Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 4th St, Wilmot, SD 57279 Phone: 605-938-4351 Fax: 605-938-4481 | |
Coteau Des Prairies Wilmot Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 409 4th St, Wilmot, SD 57279 Phone: 605-938-4351 Fax: 605-938-4481 |