Provider Demographics
NPI:1760567630
Name:ST ALEXIUS SAME DAY SURGERY CENTER
Entity Type:Organization
Organization Name:ST ALEXIUS SAME DAY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-530-5000
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-4046
Mailing Address - Country:US
Mailing Address - Phone:701-530-5000
Mailing Address - Fax:701-530-5049
Practice Address - Street 1:810 E ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58502-4046
Practice Address - Country:US
Practice Address - Phone:701-530-5000
Practice Address - Fax:701-530-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDST8622OtherBLUE CROSS BLUE SHIELD
ND011101Medicaid
ND011101Medicaid
NDN8622Medicare ID - Type Unspecified