Healthcare Provider Details

I. General information

NPI: 1518449305
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 N 26TH ST
BISMARCK ND
58501-3109
US

IV. Provider business mailing address

4800 W 57TH ST
SIOUX FALLS SD
57108-2239
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-1999
  • Fax: 701-323-1989
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIC VANDEN HULL
Title or Position: VICE PRESIDENT, FINANCE
Credential:
Phone: 605-362-5510