1437131349 NPI number — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437131349 NPI number — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

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 Other Organization Name:

Provider Other Organization Name Type Code:

6

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:

1437131349

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

11/07/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 5038

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:

57117-5038

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-362-3100

Provider Business Mailing Address Fax Number:

605-362-3265

Provider First Line Business Practice Location Address:

1415 COUNTY ROAD B W

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROSEVILLE

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55113-4216

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

651-631-1616

Provider Business Practice Location Address Fax Number:

651-631-1899

Provider Enumeration Date:

11/16/2005

Authorized Official Last Name:

NYLANDER

Authorized Official First Name:

RAYE NAE

Authorized Official Middle Name:

Authorized Official Title or Position:

CFO

Authorized Official Telephone Number:

605-362-3100

• Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 1026654 . This is a "PREFERRED ONE INPATIENT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 7100093 . This is a "PMAP EVERCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 5A23GO9 . This is a "COMPREHENSIVE CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 82516300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1026655 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 7111788 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 5A23GO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 030443 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: NH0088 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".