Provider Demographics
NPI:1578734869
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:58368-7801
Mailing Address - Country:US
Mailing Address - Phone:701-776-5455
Mailing Address - Fax:701-776-5448
Practice Address - Street 1:2975 HIGHWAY 2 E
Practice Address - Street 2:STE 100
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7801
Practice Address - Country:US
Practice Address - Phone:701-776-5235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1457110Medicaid
ND353450Medicare Oscar/Certification