Provider Demographics
NPI:1639561434
Name:ST. ALEXIUS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. ALEXIUS MEDICAL CENTER
Other - Org Name:GREAT PLAINS REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-530-7610
Mailing Address - Street 1:584 12TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3509
Mailing Address - Country:US
Mailing Address - Phone:701-456-4364
Mailing Address - Fax:701-456-4642
Practice Address - Street 1:584 12TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3509
Practice Address - Country:US
Practice Address - Phone:701-456-4364
Practice Address - Fax:701-456-4642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDWHOL1536332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1465542Medicaid
ND1465542Medicaid