Healthcare Provider Details

I. General information

NPI: 1578734869
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 10/02/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 HIGHWAY 2 E STE 100
RUGBY ND
58368-7801
US

IV. Provider business mailing address

2975 HIGHWAY 2 E
RUGBY ND
58368-7801
US

V. Phone/Fax

Practice location:
  • Phone: 701-776-5235
  • Fax:
Mailing address:
  • Phone: 701-776-5455
  • Fax: 701-776-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIK T CHRISTENSON
Title or Position: CEO
Credential:
Phone: 701-776-5261