Provider Demographics
NPI:1770637936
Name:ST ALEXIUS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST ALEXIUS MEDICAL CENTER
Other - Org Name:GREAT PLAINS REHABILITATION SERVICES-MINOT
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 1:400 BURDICK EXPY E STE 201A
Practice Address - Street 2:GREAT PLAINS REHABILITATION SERVICES MINOT
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4769
Practice Address - Country:US
Practice Address - Phone:701-857-7364
Practice Address - Fax:701-857-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26027OtherBCBS
ND50868Medicaid
ND03320003OtherBCBS ND CLINIC #
=========OtherTAX ID #
ND50868Medicaid