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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30B74GU	OTHER	MN	BLUE PLUS
2	370624200	OTHER	SD	DEPT OF LABOR
3	0006020	OTHER	SD	BCBS
4	30B74GU	OTHER	MN	BLUE CROSS
5	59767	OTHER	SD	HEALTHPARTNERS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	92411422901	OTHER	MN	PRIMEWEST
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770558405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MCKENNAN

Provider Business Mailing Address
First Line	:	PO BOX 86370
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57118-6370
Country	:	US
Telephone Number	:	605-322-7510
Fax Number	:	605-322-6475

Provider Business Practice Location Address
First Line	:	6100 S LOUISE AVE STE 1120
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-6021
Country	:	US
Telephone Number	:	605-504-1700
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	RONALD J PLACE
Credential	:
Telephone Number	:	605-322-8000

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	03/12/2026

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Directions to “AVERA MCKENNAN ” Practice Location

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