Organization
AVERA MCKENNAN
Active
Other names
Avera Breast Center Mobile
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
(605) 322-7903
Entity
Organization
Contact information
Practice address
1000 E 23RD ST, SUITE 330, SIOUX FALLS, SD 57105-2113
(605) 322-7465
Mailing address
PO BOX 5045, ATTN: PT FINAN SERVICES, SIOUX FALLS, SD 57117-5045
(605) 322-6428
Taxonomy
Speciality
Code
Description
License number
State
261QR0207X
Mobile Mammography Clinic/Center
Primary
10563
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588997365
WELLMARK BCBS SD
SD
05
—
7290300
—
SD
01
—
9290118
DAKOTACARE
—
Enumeration date
09/11/2009
Last updated
10/04/2023
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