Healthcare Provider Details

I. General information

NPI: 1861553844
Provider Name (Legal Business Name): ST. ALEXIUS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

IV. Provider business mailing address

PO BOX 5510
BISMARCK ND
58506-5510
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4616
  • Fax: 701-456-4803
Mailing address:
  • Phone: 701-530-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number5004
License Number StateND

VIII. Authorized Official

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