Provider Demographics
NPI:1184953580
Name:THOMAS HOWARD ALEXANDER JR
Entity type:Organization
Organization Name:THOMAS HOWARD ALEXANDER JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RVT
Authorized Official - Phone:903-592-8685
Mailing Address - Street 1:PO BOX 6813
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-6813
Mailing Address - Country:US
Mailing Address - Phone:903-592-8685
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 906B
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1958
Practice Address - Country:US
Practice Address - Phone:903-592-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00953757OtherRR MEDICARE
TX088029602Medicaid
TXP00953757OtherRR MEDICARE