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General NPI Number Information
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NPI Number | 1346211315
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA CLINIC PA
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 610 30TH AVE W
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City | ALEXANDRIA
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State | MN
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Zip | 56308
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Country | US
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Telephone | 320-769-5123
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Fax | 320-763-7883
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Provider Business Mailing Address
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Address Line | 610 30TH AVE W
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City | ALEXANDRIA
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State | MN
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Zip | 56308
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Country | US
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Telephone | 320-769-5123
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Fax | 320-763-7883
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ANDREW MARK LANGENFELD
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Credential |
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Telephone | 320-763-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 115
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License Number State | MN
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