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General NPI Number Information
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NPI Number | 1346266202
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Entity Type | Organization
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Legal Business Name | AVERA MCKENNAN
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 4101 W MEMORY CIR STE 135
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City | SIOUX FALLS
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State | SD
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Zip | 57107-6503
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Country | US
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Telephone | 605-322-8300
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Fax | 605-322-8361
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Provider Business Mailing Address
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Address Line | 500 E 56TH ST N STE 3150
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City | SIOUX FALLS
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State | SD
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Zip | 57104-0408
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Country | US
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Telephone | 605-322-8300
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Fax | 605-322-8361
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. RONALD JOSPEH PLACE
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Credential | MD
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Telephone | 605-322-7903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 261725
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3254
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 30747
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | Y006781
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 637
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License Number State | NE
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Taxonomy #7
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PHAR396
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License Number State | ND
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Taxonomy #8
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 100-1867
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License Number State | SD
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