Provider Demographics
NPI:1538355268
Name:THOMAS H ALEXANDER JR SERVICES
Entity type:Organization
Organization Name:THOMAS H ALEXANDER JR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER, JR.
Authorized Official - Suffix:
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 1:1301 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2239
Practice Address - Country:US
Practice Address - Phone:903-592-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS ALEXANDER JR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-17
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088029601Medicaid
TX470000349OtherRR MEDICARE
FTV002Medicare PIN