1538648225 NPI number — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538648225 NPI number — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOOD SAMARITAN SOCIETY - TYNDALL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538648225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 W 57TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57108-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2304 LAUREL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYNDALL
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57066-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-589-3350
Provider Business Practice Location Address Fax Number:
605-589-3686
Provider Enumeration Date:
08/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TRIBBLE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
GRANT
Authorized Official Title or Position:
EXECUTIVE VP
Authorized Official Telephone Number:
605-362-3900

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com