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General NPI Number Information
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NPI Number | 1710089172
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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 | 09/05/2006
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 909 NORTH IOWA AVE
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City | DELL RAPIDS
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State | SD
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Zip | 57022-1231
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Country | US
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Telephone | 605-428-5431
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Fax | 605-428-3906
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Provider Business Mailing Address
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Address Line | PO BOX 5045 ATTN PRVENROLMT PALM PLACE BLDG
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5045
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Country | US
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Telephone | 605-322-6428
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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 | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 50754
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License Number State | SD
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