Provider Demographics
NPI:1265251334
Name:ALEXANDER FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:ALEXANDER FAMILY PRACTICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:618-992-3272
Mailing Address - Street 1:2101 N AMERICA RD
Mailing Address - Street 2:
Mailing Address - City:GALATIA
Mailing Address - State:IL
Mailing Address - Zip Code:62935-2579
Mailing Address - Country:US
Mailing Address - Phone:618-992-3272
Mailing Address - Fax:618-992-3273
Practice Address - Street 1:1009 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1841
Practice Address - Country:US
Practice Address - Phone:186-992-3272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty