Healthcare Provider Details

I. General information

NPI: 1639561434
Provider Name (Legal Business Name): ST. ALEXIUS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 12TH ST W
DICKINSON ND
58601-3509
US

IV. Provider business mailing address

584 12TH ST W
DICKINSON ND
58601-3509
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4364
  • Fax: 701-456-4642
Mailing address:
  • Phone: 701-456-4364
  • Fax: 701-456-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberWHOL1536
License Number StateND

VIII. Authorized Official

Name: PAUL MORRIS
Title or Position: CFO
Credential:
Phone: 701-530-7610