MEDICARE: THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BN1400X	Nursing Facility Supplies (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4690MO	OTHER	MN	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NH0330	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1265423990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Provider Business Mailing Address
First Line	:	PO BOX 5038
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5038
Country	:	US
Telephone Number	:	605-362-3100
Fax Number	:	605-362-3265

Provider Business Practice Location Address
First Line	:	745 BASINGER MEMORIAL DR
Second Line	:
City	:	MOUNTAIN LAKE
State	:	MN
Zip	:	56159-1312
Country	:	US
Telephone Number	:	507-427-2464
Fax Number	:	507-427-3036

Authorized Official
Title or Position	:	CFO
Name	:	MRS. RAYE NAE NYLANDER
Credential	:
Telephone Number	:	605-362-3100

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	11/28/2021

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Directions to “THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY ” Practice Location

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