MEDICARE: AVERA MCKENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	50M77UN	OTHER	MN	BLUE PLUS/CC SYSTEMS
3	81G87AV	OTHER	MN	BCBS MN
4	22591	OTHER	IA	BCBS IA
5	86467	OTHER	SD	HEALTHPARTNERS
6	0040470	OTHER	SD	BCBS
7	040121002	OTHER	MN	PRIMEWEST
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	81G97AV	OTHER	MN	BLUE PLUS/CCS

General Provider Information

NPI Number	:	1013980598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	4400 W 69TH ST STE 1500
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-8171
Country	:	US
Telephone Number	:	605-322-5700
Fax Number	:	605-322-5704

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	RONALD J PLACE
Credential	:
Telephone Number	:	605-322-8000

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/12/2026

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Directions to “AVERA MCKENNAN ” Practice Location

Language	Start Address	Practice Location

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