Organization
AVERA MCKENNAN
Active
Other names
Avera McKennan Hospital CRNA
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
(605) 322-7903
Entity
Organization
Contact information
Practice address
1325 S CLIFF AVE, SIOUX FALLS, SD 57105-1007
(605) 322-6400
(605) 322-6499
Mailing address
PO BOX 5045, ATTN: P.F.S. PROV ENROLLMENT, SIOUX FALLS, SD 57117-5045
(605) 322-6400
(605) 322-6499
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10563
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100160
—
SD
05
—
0965731
—
IA
Enumeration date
07/24/2007
Last updated
10/04/2023
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