Provider Demographics
NPI:1831267236
Name:ST. ALEXIUS MEDICAL CENTER
Entity type:Organization
Organization Name:ST. ALEXIUS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-448-2331
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0280
Mailing Address - Country:US
Mailing Address - Phone:701-448-2331
Mailing Address - Fax:701-448-2441
Practice Address - Street 1:1177 BORDER LN
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:ND
Practice Address - Zip Code:58577-4102
Practice Address - Country:US
Practice Address - Phone:701-442-3396
Practice Address - Fax:701-462-3422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-01
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455046Medicaid
ND1455045Medicaid
NDN6303Medicare PIN
ND353434Medicare Oscar/Certification