Healthcare Provider Details

I. General information

NPI: 1063663607
Provider Name (Legal Business Name): ST ALEXIUS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

900 E BROADWAY AVE
BISMARCK ND
58501
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-4100
  • Fax: 701-530-6891
Mailing address:
  • Phone: 701-530-4100
  • Fax: 701-530-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number190
License Number StateND

VIII. Authorized Official

Name: AMBER STOWMAN
Title or Position: CFO
Credential:
Phone: 701-530-7000