Provider Demographics
NPI:1548479397
Name:ION ALEXIE, INC
Entity type:Organization
Organization Name:ION ALEXIE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ION
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIE
Authorized Official - Suffix:
Authorized Official - Credentials:ME
Authorized Official - Phone:702-884-6826
Mailing Address - Street 1:PO BOX 80783
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-0783
Mailing Address - Country:US
Mailing Address - Phone:702-228-5800
Mailing Address - Fax:
Practice Address - Street 1:2435 FIRE MESA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9009
Practice Address - Country:US
Practice Address - Phone:702-968-2437
Practice Address - Fax:702-479-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7961207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501291Medicaid
NV100501291Medicaid
NVDB7056Medicare ID - Type UnspecifiedRR MEDICARE GRP NUMBER