1255454336 NPI number — JAMES G ALEXANDER JR DDS MD PLLC

Table of content: (NPI 1255454336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255454336 NPI number — JAMES G ALEXANDER JR DDS MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES G ALEXANDER JR DDS MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255454336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 W TYLER AVE STE 307
Provider Second Line Business Mailing Address:
P.O. BOX 907
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72303-0907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-735-1152
Provider Business Mailing Address Fax Number:
870-735-4098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 W TYLER AVE
Provider Second Line Business Practice Location Address:
STE 307
Provider Business Practice Location Address City Name:
WEST MEMPHIS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72301-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-735-1152
Provider Business Practice Location Address Fax Number:
870-735-4098
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PLLC MEMBER
Authorized Official Telephone Number:
870-735-1152

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  AR3562 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112939001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4185464 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50999 . This is a "ABCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 59309 . This is a "AR M'CARE GROUP PTAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00219773 . This is a "RR MEDICARE INDIVIDUAL PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4112951 . This is a "TENNESSEE BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: DD2979 . This is a "RR MEDICARE GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50999 . This is a "AR M'CARE GROUP MBR PTAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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