1497736169 NPI number — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Table of content: (NPI 1497736169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497736169 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:
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 Information

NPI Number:
1497736169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 WEST 57TH STREET P.O. 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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 SUMMIT AVENUE WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKDUCK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-835-4218
Provider Business Practice Location Address Fax Number:
218-835-6737
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • 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" .

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

  • Identifier: 8720NO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 08629 . This is a "BLUE CROSS BS OF MICHIGAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 336240000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01026602 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7122574 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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