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General NPI Number Information
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NPI Number | 1982154993
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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 | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 216 SAMARITAN CIR
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City | BELINGTON
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State | WV
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Zip | 26250-8141
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Country | US
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Telephone | 304-823-2555
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Fax | 304-823-3136
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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 | 605-362-3100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VP - FINANCE
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Name | GRANT TRIBBLE
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Credential |
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Telephone | 605-362-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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