| NPI | 1649759499 |
|---|---|
| Doing Business As | GOOD SAMARITAN SOCIETY - WAGNER |
| Entity Type | Organization |
| Authorized Contact | GEORGE GRANT TRIBBLE Executive VP 605-362-3900 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2018-08-13 |