Healthcare Provider Details

I. General information

NPI: 1215951629
Provider Name (Legal Business Name): AVERA MCKENNAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE REHABILITATION UNIT
SIOUX FALLS SD
57105-1007
US

IV. Provider business mailing address

PO BOX 5045 ATTN: P.F.S.
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-6400
  • Fax: 605-322-6499
Mailing address:
  • Phone: 605-322-6400
  • Fax: 605-322-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number10563
License Number StateSD

VIII. Authorized Official

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