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Organization

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Luther Manor
Organization subpart
Yes

Provider details

NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
GRANT TRIBBLE (EXECUTIVE VP)
(605) 362-3100
Entity
Organization

Contact information

Practice address
1500 W 38TH ST, SIOUX FALLS, SD 57105-5563
(605) 336-1997
(605) 336-8703
Mailing address
4800 W 57TH ST, SIOUX FALLS, SD 57108-2239
(605) 362-3100

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
S109080
MEDICARE PART B
Enumeration date
07/10/2015
Last updated
07/10/2015
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