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General NPI Number Information
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NPI Number | 1760961452
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Entity Type | Organization
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Legal Business Name | THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 501 E FRONT ST
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City | LARIMORE
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State | ND
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Zip | 58251-4010
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Country | US
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Telephone | 701-247-2902
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Fax | 701-247-2608
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Provider Business Mailing Address
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Address Line | 4800 W 57TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VP
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Name | GEORGE GRANT TRIBBLE
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Credential |
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Telephone | 605-362-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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