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	261Q00000X	Clinic/Center		ND
2	261QR1300X	Rural Health Clinic/Center		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831267236
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	:	1177 BORDER LN
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-4102
Country	:	US
Telephone Number	:	701-442-3396
Fax Number	:	701-462-3422

Authorized Official
Title or Position	:	ASSISTANT ADMINISTRATOR
Name	:	KATHY HANSON
Credential	:
Telephone Number	:	701-448-2331

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	01/04/2018

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