Organization
AVERA MCKENNAN
Active
Organization
AVERA MCKENNAN
Active
Other names
Avera Medical Group Milbank
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD JOSEPH PLACE MD (PRESIDENT/CEO)
(605) 322-7903
Entity
Organization
Contact information
Practice address
301 FLYNN DR, MILBANK, SD 57252-1508
(605) 432-4587
Mailing address
PO BOX 5045, CBO PROV ENRLMT, SIOUX FALLS, SD 57117-5045
(605) 322-6428
(605) 432-4580
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10148
MEDICAID SD
SD
01
—
148019700
MN MEDICAID
—
01
—
43D0407375
CLIA
—
Enumeration date
09/20/2006
Last updated
03/12/2024
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