Provider Demographics
NPI:1063663607
Name:ST ALEXIUS MEDICAL CENTER
Entity type:Organization
Organization Name:ST ALEXIUS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWMAN
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
Mailing Address - Country:US
Mailing Address - Phone:701-530-4100
Mailing Address - Fax:701-530-6891
Practice Address - Street 1:900 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4520
Practice Address - Country:US
Practice Address - Phone:701-530-4100
Practice Address - Fax:701-530-6891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONSPIRIT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-01
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1903336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1461036Medicaid
NDN720860Medicare PIN