Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera Dialysis Mitchell
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
(605) 322-7903
Entity
Organization
Contact information
Practice address
1900 GRASSLAND DR, STE 102, MITCHELL, SD 57301-6205
(605) 995-6730
Mailing address
PO BOX 5045, ATTN: P.F.S. PROV ENRLLMT, SIOUX FALLS, SD 57117-5045
(605) 322-6428
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
10563
SD
Other
Enumeration date
11/03/2014
Last updated
09/13/2023
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