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General NPI Number Information
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NPI Number | 1609882018
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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 | 07/31/2006
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 1325 S CLIFF AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1007
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Country | US
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Telephone | 605-322-8000
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Fax | 605-322-6499
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Provider Business Mailing Address
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Address Line | 1325 S CLIFF AVE PO BOX 5045 ATTN: PT FINANCIAL SERVICES
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City | SIOUX FALLS
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State | SD
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Zip | 57105-1007
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Country | US
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Telephone | 605-322-8000
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Fax | 605-322-6499
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RONALD JOSEPH 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 | 10563
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License Number State | SD
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