Healthcare Provider Details

I. General information

NPI: 1659435105
Provider Name (Legal Business Name): ST. ALEXIUS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E MAIN AVE
BISMARCK ND
58501-4518
US

IV. Provider business mailing address

1212 E MAIN AVE
BISMARCK ND
58501-4518
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-4000
  • Fax: 701-530-4001
Mailing address:
  • Phone: 701-530-4000
  • Fax: 701-530-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7816
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBC BS
# 2
IdentifierMEDICA
Identifier TypeOTHER
Identifier State
Identifier Issuer8200734
# 3
Identifier03320001
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBCBS ND CLINIC #
# 4
Identifier76916GR
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBC BS
# 5
Identifier8200734
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICA INS
# 6
Identifier141797700
Identifier TypeOTHER
Identifier StateND
Identifier IssuerFEDERAL WORKFORCE SAFETY
# 7
Identifier5600803
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer
# 8
Identifier15-00713-1
Identifier TypeOTHER
Identifier StateMT
Identifier IssuerDEPT OF LABOR
# 9
Identifier55980
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 10
IdentifierYP32445A
Identifier TypeOTHER
Identifier StateND
Identifier IssuerTRANSAMERICA OCCI LIFE
# 11
Identifier9150410
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 12
Identifier310990
Identifier TypeOTHER
Identifier StateMT
Identifier IssuerBC BS
# 13
Identifier8200735
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICA INS
# 14
Identifier1457725
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 15
Identifier9052028
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWORKFORCE SAFETY
# 16
Identifier9164400
Identifier TypeOTHER
Identifier StateND
Identifier IssuerOFFICE OF MEDICAL SERVICE

VIII. Authorized Official

Name: PAUL MORRIS
Title or Position: CFO
Credential:
Phone: 701-530-7000