MEDICARE: ALEXANDER MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1972150738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	12416 66TH ST STE A
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3430
Country	:	US
Telephone Number	:	727-547-4700
Fax Number	:	727-394-8661

Provider Business Practice Location Address
First Line	:	2438 DR. M L KING JR STREET N
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33704
Country	:	US
Telephone Number	:	727-547-4700
Fax Number	:	727-394-8661

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SHERRY D JACKASAL LABONTE
Credential	:
Telephone Number	:	727-547-4700

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	06/05/2020

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Directions to “ALEXANDER MEDICAL GROUP LLC ” Practice Location

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