Basic Information
| Provider Information | |||||||||
| NPI: | 1417001751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST ALEXIUS MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GREAT PLAINS HEALTH COMPANY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015307000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3222 28TH ST SW | ||||||||
| Address2: | GREAT PLAINS HEALTH COMPANY | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581045183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012323000 | ||||||||
| FaxNumber: | 7012323005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7015307000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332BN1400X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 335E00000X | N | Suppliers | Prosthetic/Orthotic Supplier | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 23337 | 01 | ND | BCBS | OTHER | 54594 | 05 | ND | MEDICAID | 8200403 | 01 | MEDICA INS | OTHER | 8200402 | 01 | MEDICA INS | OTHER | 05957001 | 01 | ND | BCBS ND CLINIC # | OTHER | 259M7GR | 01 | MN | BLUE PLUS MN MEDICAID | OTHER |