Avera McKennan
Organization Active NPI Specialty Pharmacy · Sioux Falls, SD
NPI 1346266202 · NPPES record last updated Jul 24, 2025
Key facts
- NPI
- 1346266202
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialty Pharmacy 3336S0011X
- License
- 100-1867 (SD)
- Legal business name
- AVERA MCKENNAN
- Practice address
- 4101 W Memory Cir Ste 135
Sioux Falls, SD 57107-6503 - Phone
- (605) 322-8300
- Fax
- (605) 322-8361
- NPI assigned
- Jul 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Ronald Jospeh Place, MD
- Title
- President/Ceo
- Phone
- (605) 322-7903
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 24
Member of 1
Practitioners 3
-
Amy Ross, PHARMD
-
Matthew J Toennies, PHARM D.
-
Paul W. Smith, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SD
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| Avera Heart Hospital of South Dakota |
Hospital | 5% Or Greater Direct Ownership Interest (33.33%) | Oct 1, 2010 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Oct 6, 1994 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2007 |
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| United Living Community |
Skilled nursing facility | Operational/Managerial Control | Nov 15, 2005 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081124000161 | SD | Part B Supplier - Mass Immunization (Roster Biller Only) | 0345157103 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Aberdeen, SD; Sioux Falls, SD |
| O20100930049879 | SD | DME Supplier - Pharmacy | 0345157103 | Practice locations: Sioux Falls, SD |
National Provider Directory
- Tax ID family
- Avera McKennan Hosp
Locations
4101 W Memory Cir
Ste 135
Sioux Falls, SD 57107
Phone (605) 322-8300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 261725 | MN | |
| Community/Retail Pharmacy | 3336C0003X | 3254 | IA | |
| Specialty Pharmacy | 3336S0011X | 30747 | TX | |
| Specialty Pharmacy | 3336S0011X | Y006781 | AZ | |
| Specialty Pharmacy | 3336S0011X | 100-1867 | SD | Yes |
| Specialty Pharmacy | 3336S0011X | 637 | NE | |
| Specialty Pharmacy | 3336S0011X | PHAR396 | ND |
Addresses
Primary practice location
4101 W Memory Cir Ste 135
Sioux Falls, SD 57107-6503
Mailing address
500 E 56TH St N Ste 3150
Sioux Falls, SD 57104-0408
Phone (605) 322-8300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2094315 | Other | PK | |
| 1346266202 | Medicaid | MN | |
| 100261606-00 | Medicaid | NE | |
| 1346266202 | Medicaid | IA | |
| 8504220 | Medicaid | SD |
Other names
- Avera Specialty Pharmacy
Other providers in Sioux Falls, SD
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
- Avera McKennan
All providers in Sioux Falls, SD · Specialty Pharmacy in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.