MEDICARE: ALEXANDER'S CHILDREN SERVICES, INC.

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	261QP2300X	Primary Care Clinic/Center	AP103698	TX

General Provider Information

NPI Number	:	1306368436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER'S CHILDREN SERVICES, INC.

Provider Business Mailing Address
First Line	:	2128 PROCTER ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-6752
Country	:	US
Telephone Number	:	409-983-1882
Fax Number	:	409-983-1823

Provider Business Practice Location Address
First Line	:	2128 PROCTER ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-6752
Country	:	US
Telephone Number	:	409-983-1882
Fax Number	:	409-983-1823

Authorized Official
Title or Position	:	CERTIFIED PEDIATRIC NURSE PRACTITIO
Name	:	MR. GLENN E ALEXANDER SR.
Credential	:	BS, BSN, RN, CPNP
Telephone Number	:	409-983-1882

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/21/2022

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