Provider Demographics
NPI:1154457646
Name:GOOD SAMARITAN HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-776-5261
Mailing Address - Street 1:2975 HIGHWAY 2 E
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368
Mailing Address - Country:US
Mailing Address - Phone:701-776-5261
Mailing Address - Fax:701-776-5448
Practice Address - Street 1:2975 HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7801
Practice Address - Country:US
Practice Address - Phone:701-776-5261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11866OtherBLUE CROSS BLUE SHIELD
ND1457282Medicaid