Provider Demographics
NPI:1417001751
Name:ST ALEXIUS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST ALEXIUS MEDICAL CENTER
Other - Org Name:GREAT PLAINS HEALTH COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-530-7000
Mailing Address - Street 1:900 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4520
Mailing Address - Country:US
Mailing Address - Phone:701-530-7000
Mailing Address - Fax:
Practice Address - Street 1:3222 28TH ST SW
Practice Address - Street 2:GREAT PLAINS HEALTH COMPANY
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5183
Practice Address - Country:US
Practice Address - Phone:701-232-3000
Practice Address - Fax:701-232-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23337OtherBCBS
ND54594Medicaid
8200403OtherMEDICA INS
8200402OtherMEDICA INS
ND05957001OtherBCBS ND CLINIC #
MN259M7GROtherBLUE PLUS MN MEDICAID
ND23337OtherBCBS
8200402OtherMEDICA INS