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General NPI Number Information
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NPI Number | 1265251334
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Entity Type | Organization
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Legal Business Name | ALEXANDER FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 02/16/2025
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Provider Practice Location Address
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Address Line | 1009 W MAIN ST
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City | MARION
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State | IL
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Zip | 62959-1841
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Country | US
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Telephone | 186-992-3272
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 N AMERICA RD
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City | GALATIA
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State | IL
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Zip | 62935-2579
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Country | US
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Telephone | 618-992-3272
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Fax | 618-992-3273
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER L ALEXANDER
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Credential | PA-C
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Telephone | 618-992-3272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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