Healthcare Provider Details

I. General information

NPI: 1619891850
Provider Name (Legal Business Name): AVERA MCKENNAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 OUTER DR N
SIOUX CITY IA
51104-1590
US

IV. Provider business mailing address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-2667
  • Fax:
Mailing address:
  • Phone: 605-217-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RONALD PLACE
Title or Position: REGIONAL PRESIDENT/CEO
Credential: MD
Phone: 605-322-7903