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	282N00000X	General Acute Care Hospital	10563	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80016	OTHER	SD	SD BLUE CROSS
2	CCDP00004	OTHER	SD	CHF RESEARCH PROJECT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568460772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	PO BOX 9191
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55480-9191
Country	:	US
Telephone Number	:	605-322-6400
Fax Number	:	605-322-6499

Provider Business Practice Location Address
First Line	:	1325 S CLIFF AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1007
Country	:	US
Telephone Number	:	605-322-6400
Fax Number	:	605-322-6499

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	09/13/2023

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Directions to “AVERA MCKENNAN ” Practice Location

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