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Contact Information

AVERA MCKENNAN
1325 S CLIFF AVE
SUITE CP
SIOUX FALLS, SD57105-1008
 Phone: 605-322-8326
 Fax: 605-322-8330
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for AVERA MCKENNAN

NPI # 1750442901
LBN Legal business name AVERA MCKENNAN
Authorized official RONALD PLACE - (PRESIDENT/CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 12/12/2006
Last updated 10/06/2023 - About 3 years ago
Identifiers
SD License # 1000452
IA Medicaid 1750442901
MN Medicaid 1750442901
SD Medicaid 8503150
Other 4304010 OTHER ID NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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