| White Lake Medical Clinic Avera | |
|
306 S Johnston St White Lake SD 57383-2251 | |
| (605) 337-1529 | |
| (605) 249-2344 |
| Full Name | White Lake Medical Clinic Avera |
|---|---|
| Speciality | Clinic/Center |
| Location | 306 S Johnston St, White Lake, South Dakota |
| Authorized Official Name and Position | Mark M. Burket (CEO) |
| Authorized Official Contact | 6053373364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White Lake Medical Clinic Avera 306 S Johnston St White Lake SD 57383-2251 Ph: (605) 337-1529 | White Lake Medical Clinic Avera 306 S Johnston St White Lake SD 57383-2251 Ph: (605) 337-1529 |
| NPI Number | 1477942878 |
|---|---|
| Provider Enumeration Date | 01/22/2015 |
| Last Update Date | 03/11/2024 |
| Medicare PECOS PAC ID | 6507770054 |
|---|---|
| Medicare Enrollment ID | O20150318002342 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477942878 | NPI | - | NPPES |
| 5301160 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 10557 (South Dakota) | Primary |
White Lake Medical Clinic Avera Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 306 S Johnston St, White Lake, SD 57383 Phone: 605-337-1529 Fax: 605-337-2670 |