Provider Demographics
NPI:1568633865
Name:GOOD SAMARITAN HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL ASSOCIATION
Other - Org Name:HEART OF AMERICA JOHNSON CLINIC - DUNSEITH
Other - Org Type:Other Name
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 1:800 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2118
Mailing Address - Country:US
Mailing Address - Phone:701-776-5261
Mailing Address - Fax:701-776-5448
Practice Address - Street 1:215 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:DUNSEITH
Practice Address - State:ND
Practice Address - Zip Code:58329
Practice Address - Country:US
Practice Address - Phone:701-224-5694
Practice Address - Fax:701-244-5329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1457111Medicaid
ND5186Medicaid