1689655086 NPI number — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Table of content: (NPI 1689655086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689655086 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:
1689655086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 13TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWARD LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55349-9409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-543-3800
Provider Business Practice Location Address Fax Number:
320-543-2305
Provider Enumeration Date:
11/11/2005

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: NH0201 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 040909001 . This is a "PRIME WEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100091 . This is a "PMAP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1026620 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5A17HO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 608716700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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