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General NPI Number Information
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NPI Number | 1891619037
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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 | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 201 E 4TH ST STE 202
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City | SOUTH SIOUX CITY
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State | NE
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Zip | 68776-9928
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Country | US
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Telephone | 605-217-2667
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Fax |
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Provider Business Mailing Address
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Address Line | 575 N SIOUX POINT RD
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5312
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Country | US
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Telephone | 605-217-2667
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Fax |
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Authorized Official
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Title or Position | REGIONAL PRESIDENT/CEO
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Name | RONALD 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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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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 | 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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