Healthcare Provider Details

I. General information

NPI: 1336283928
Provider Name (Legal Business Name): ST ALEXIUS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVENUE
BISMARCK ND
58501
US

IV. Provider business mailing address

900 E BROADWAY AVENUE
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6906
  • Fax: 701-530-8842
Mailing address:
  • Phone: 701-530-6906
  • Fax: 701-530-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number190
License Number StateND

VIII. Authorized Official

Name: RICK DETWILLER
Title or Position: PHARMACIST
Credential: R.PH.
Phone: 701-530-6926