Avera McKennan
Organization Active NPI Clinical Medical Laboratory · Sioux Falls, SD
NPI 1891718136 · NPPES record last updated Nov 12, 2020
Key facts
- NPI
- 1891718136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Medical Laboratory 291U00000X
- License
- 43D0658878 (SD)
- Legal business name
- AVERA MCKENNAN
- Practice address
- 1301 S Cliff Ave
Regional Lab
Sioux Falls, SD 57105-1005 - Phone
- (605) 322-7187
- Fax
- (605) 322-7183
- NPI assigned
- Jul 26, 2006
- Organization subpart
- No
Authorized official
- Name
- David Flicek
- Title
- President/Ceo
- Phone
- (605) 322-7916
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 22
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 43D0658878 | Avera McKennan Hospital | Accreditation | Feb 27, 2027 |
| 43D0658888 | Physicians Laboratory LTD | Accreditation | Feb 23, 2028 |
| 43D2171470 | Avera Orthopedic Hospital | Accreditation | Oct 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| Avera Heart Hospital of South Dakota |
Hospital | 5% Or Greater Direct Ownership Interest (33.33%) | Oct 1, 2010 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Oct 6, 1994 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2007 |
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| United Living Community |
Skilled nursing facility | Operational/Managerial Control | Nov 15, 2005 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040205000938 | SD | Part B Supplier - Independent Clinical Laboratory | 0345157103 |
1 other NPI on this enrollment Practice locations: Sioux Falls, SD |
National Provider Directory
- Tax ID family
- Avera McKennan Hosp
Locations
6100 S Louise Ave
Ste 1245
Sioux Falls, SD 57108
2100 S Marion Rd
Ste 105
Sioux Falls, SD 57106
Phone (605) 322-7187
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | 43D0658878 | SD | Yes |
Addresses
Primary practice location
1301 S Cliff Ave
Regional Lab
Sioux Falls, SD 57105-1005
Mailing address
PO Box 5045
Attn: P.F.S.
Sioux Falls, SD 57117-5045
Phone (605) 322-7187
Other practice location 1
6100 S Louise Ave
Sioux Falls, SD 57108-6029
Phone (605) 322-7187
Other practice location 2
2100 S Marion Rd Ste 105
Sioux Falls, SD 57106-3647
Phone (605) 322-7187
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4995742 | Other | SD | BLUE CROSS OF SD |
| 604999 | Other | SD | ARAZ |
| 5580610 | Medicaid | SD | |
| 1034593 | Other | SD | PREFERRED ONE |
| 165L6AV | Other | MN | BLUE CROSS OF MINNESOTA |
| F230764 | Other | SD | MIDLANDS CHOICE |
| 0569285 | Medicaid | IA |
Other names
- Avera McKennan Regional Lab
Other providers in Sioux Falls, SD
- Avera McKennan
- Avera McKennan
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- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
All providers in Sioux Falls, SD · Clinical Medical Laboratory in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.