Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Sioux Falls Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
GRANT TRIBBLE (EXECUTIVE VP)
60053623100
Entity
Organization
Contact information
Practice address
401 W 2ND ST, SIOUX FALLS, SD 57104-2313
(605) 336-6252
(605) 333-5366
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
07/09/2015
Last updated
07/09/2015
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