Healthcare Provider Details

I. General information

NPI: 1346211315
Provider Name (Legal Business Name): ALEXANDRIA CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVE W
ALEXANDRIA MN
56308
US

IV. Provider business mailing address

610 30TH AVE W
ALEXANDRIA MN
56308
US

V. Phone/Fax

Practice location:
  • Phone: 320-769-5123
  • Fax: 320-763-7883
Mailing address:
  • Phone: 320-769-5123
  • Fax: 320-763-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number115
License Number StateMN

VIII. Authorized Official

Name: ANDREW MARK LANGENFELD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 320-763-2527