# AVERA MCKENNAN

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AVERA MCKENNAN
- **Other names:** Avera CNOS Northside DME
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619891850
- **Legal business name:** AVERA MCKENNAN
- **Authorized official:** RONALD PLACE MD (REGIONAL PRESIDENT/CEO)
- **Authorized official phone:** (605) 322-7903

## Contact information

- **Practice address:** 2735 OUTER DR N, SIOUX CITY, IA 51104-1590
- **Practice address phone:** (605) 217-2667
- **Mailing address:** 575 N SIOUX POINT RD, DAKOTA DUNES, SD 57049-5312
- **Mailing address phone:** (605) 217-2667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 08/10/2026
- **Last updated:** 08/31/2026