NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera McKennan Fitness Center

  • Massage Therapist
  • Sioux Falls, SD
National Provider Identifier
1629544473
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
Legal business name
AVERA MCKENNAN
Doing business as
Avera McKennan Fitness Center
Practice address
3400 S Southeastern Ave
Sioux Falls, SD 57103-7184
Phone
(605) 322-5300
NPI assigned
Oct 19, 2018
Last updated
Oct 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David William Flicek
Title
President/Ceo
Phone
(605) 322-7915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Massage Therapist 225700000X Primary

Addresses

Primary practice location

3400 S Southeastern Ave
Sioux Falls, SD 57103-7184

Mailing address

3400 S Southeastern Ave
Sioux Falls, SD 57103-7184
Phone (605) 322-5300

Other names 1

  • Avera McKennan Fitness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Amg Radiology105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539907200000",
    "number": "1629544473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 S SOUTHEASTERN AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571037184",
            "telephone_number": "605-322-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 S SOUTHEASTERN AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571037184",
            "telephone_number": "605-322-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-19",
        "last_updated": "2018-10-19",
        "status": "A",
        "authorized_official_last_name": "FLICEK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7915"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera McKennan Fitness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.