MEDICARE: AVERA MCKENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	10722	SD
2	314000000X	Skilled Nursing Facility	10722	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	85066	OTHER	SD	BLUE CROSS OF SD

General Provider Information

NPI Number	:	1508854340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	4500 S PRINCE OF PEACE PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5830
Country	:	US
Telephone Number	:	605-322-5600
Fax Number	:	605-322-5622

Provider Business Practice Location Address
First Line	:	4513 S PRINCE OF PEACE PL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-5830
Country	:	US
Telephone Number	:	605-322-5600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	RONALD JOSEPH PLACE
Credential	:	MD
Telephone Number	:	605-322-7903

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/04/2023

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1043279383 — DR. ANDREW WADE BURCHETT D.O.
Practice Location Address:

4509 S PRINCE OF PEACE PL
SIOUX FALLS, SD
57103-5830

Practice Phone: 605-322-7705
Practice Fax: 605-322-7713

1467474239 — AVERA AT HOME
Practice Location Address:

4509 PRINCE OF PEACE PL , HOSPICE UNIT
SIOUX FALLS, SD
57103-5830

Practice Phone: 605-322-5490
Practice Fax: 605-322-3179

1700070307 — MRS. JODIE MCMACKEN THORSON OTR/L
Practice Location Address:

4500 S PRINCE OF PEACE PL , SUITE 1
SIOUX FALLS, SD
57103-5830

Practice Phone: 605-322-5618
Practice Fax:

1780849869 — RENEE KNEIP O.T.
Practice Location Address:

4500 S PRINCE OF PEACE PL , SUITE 1
SIOUX FALLS, SD
57103-5830

Practice Phone: 605-322-5600
Practice Fax:

1376708446 — STEPHANIE ANN RAHN I P.T.
Practice Location Address:

4500 S PRINCE OF PEACE PL
SIOUX FALLS, SD
57103-5830

Practice Phone: 605-322-5600
Practice Fax:

Directions to “AVERA MCKENNAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.