1841272226 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 1841272226 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:
1841272226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2025
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:
503 3RD ST NE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-247-1378
Provider Business Practice Location Address Fax Number:
218-773-0396
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHANSEN
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
605-362-3100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54912 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98871 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 34339 . This is a "QUALIFIED PROVIDER SERVIC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 3674 . This is a "VA" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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