Healthcare Provider Details

I. General information

NPI: 1285113977
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HAZEL AVE
HOWARD SD
57349-8700
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 605-772-4481
  • Fax: 605-772-4484
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GEORGE GRANT TRIBBLE
Title or Position: EXECUTIVE VP
Credential:
Phone: 605-362-3900