Provider Demographics
NPI:1821044652
Name:LUTHERAN CHARITY ASSOCIATION
Entity Type:Organization
Organization Name:LUTHERAN CHARITY ASSOCIATION
Other - Org Name:JAMESTOWN REGIONAL MEDICAL CENTER PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELFS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-952-4850
Mailing Address - Street 1:2422 20TH ST SW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-6201
Mailing Address - Country:US
Mailing Address - Phone:701-252-1050
Mailing Address - Fax:701-952-3265
Practice Address - Street 1:2422 20TH ST SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-6201
Practice Address - Country:US
Practice Address - Phone:701-252-1050
Practice Address - Fax:701-952-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455026Medicaid
ND00124001OtherBLUE SHIELD ERP
NDA001OtherTRICARE ERP
CC6238OtherRR MEDICARE
NDA001OtherTRICARE ERP