Provider Demographics
NPI:1154350064
Name:AVERA MCKENNAN
Entity type:Organization
Organization Name:AVERA MCKENNAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-322-7903
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:CBO PROVENRLMT PALM PLACE
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-6428
Mailing Address - Fax:605-322-6499
Practice Address - Street 1:909 NORTH IOWA AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1231
Practice Address - Country:US
Practice Address - Phone:605-428-5431
Practice Address - Fax:605-428-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD50754282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN102355100Medicaid
SD5500450Medicaid
SD1026470OtherPREFERRED ONE
SD0040666OtherSD BLUE CROSS CRNA GROUP
MN3F59HDEOtherMN BLUECROSS BS
SD43-0082OtherDAKOTACARE
SD543140OtherARAZ
SD0100450Medicaid
IA0584227Medicaid
SD1202730015Medicare NSC
SD1026470OtherPREFERRED ONE