Healthcare Provider Details

I. General information

NPI: 1164492906
Provider Name (Legal Business Name): AVERA MCKENNAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 W MEMORY CIR STE 110
SIOUX FALLS SD
57107-6504
US

IV. Provider business mailing address

4101 W MEMORY CIR STE 110
SIOUX FALLS SD
57107-6504
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8322
  • Fax: 605-322-8317
Mailing address:
  • Phone: 605-322-8322
  • Fax: 605-322-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number100-1663
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100-1663
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number100-1663
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100-1663
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1001663
License Number StateSD
# 6
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number1001663
License Number StateSD

VIII. Authorized Official

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