Healthcare Provider Details

I. General information

NPI: 1538355268
Provider Name (Legal Business Name): THOMAS H ALEXANDER JR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 DOCTORS DR
TYLER TX
75701-2239
US

IV. Provider business mailing address

PO BOX 6813
TYLER TX
75711-6813
US

V. Phone/Fax

Practice location:
  • Phone: 903-592-8685
  • Fax:
Mailing address:
  • Phone: 903-592-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS ALEXANDER, JR.
Title or Position: SOLE PROPRIETOR
Credential: R.V.T.
Phone: 903-592-8685