Healthcare Provider Details

I. General information

NPI: 1336708536
Provider Name (Legal Business Name): ST. ALEXIUS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVE W
TURTLE LAKE ND
58575-4324
US

IV. Provider business mailing address

PO BOX 280
TURTLE LAKE ND
58575-0280
US

V. Phone/Fax

Practice location:
  • Phone: 701-448-2331
  • Fax: 701-448-2441
Mailing address:
  • Phone: 701-448-2331
  • Fax: 701-448-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOD S GRAEBER
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-463-6505