Provider Demographics
NPI:1659588341
Name:ALEXANDER DIXIE V
Entity type:Organization
Organization Name:ALEXANDER DIXIE V
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW AAPS SAP
Authorized Official - Phone:620-442-1313
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-1012
Mailing Address - Country:US
Mailing Address - Phone:620-442-1313
Mailing Address - Fax:620-442-2808
Practice Address - Street 1:325 NORTH 1ST
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-1012
Practice Address - Country:US
Practice Address - Phone:620-442-1313
Practice Address - Fax:620-442-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 1041C0700X
KSLSCSW10121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS41070OtherBLUE CROSS BLUE SHIELD OF
24041071ALMedicare ID - Type Unspecified
041070CUMedicare UPIN