MEDICARE: ST. ALEXIUS MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	5059	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013961820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ALEXIUS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 280
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-0280
Country	:	US
Telephone Number	:	701-448-2331
Fax Number	:	701-448-2441

Provider Business Practice Location Address
First Line	:	220 5TH AVE W
Second Line	:
City	:	TURTLE LAKE
State	:	ND
Zip	:	58575-4324
Country	:	US
Telephone Number	:	701-448-2331
Fax Number	:	701-448-2441

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TOD GRAEBER
Credential	:
Telephone Number	:	701-463-6505

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/21/2017

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