# THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- **Other names:** Good Samaritan Society - Lakota
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1851870984
- **Legal business name:** THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- **Authorized official:** GEORGE GRANT TRIBBLE (EXECUTIVE VP)
- **Authorized official phone:** (605) 362-3900

## Contact information

- **Practice address:** 608 4TH AVE SW, LAKOTA, ND 58344-7500
- **Practice address phone:** (701) 247-2902
- **Mailing address:** 608 4TH AVE SW, LAKOTA, ND 58344-7500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/09/2018
- **Last updated:** 08/09/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000 | MEDICARE PART B | — |