Organization
VINE ST CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD B ALEXANDER M.D. (PARTNER)
(217) 726-7300
Entity
Organization
Contact information
Practice address
3225 HEDLEY RD, SPRINGFIELD, IL 62711-6248
(217) 726-7300
(217) 726-5989
Mailing address
3225 HEDLEY RD, PO BOX 13484, SPRINGFIELD, IL 62711-6248
(217) 726-7300
(217) 726-5989
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08415473
BLUE CROSS BLUE SHIELD
IL
01
—
CL5057
RAILROAD MEDICARE
GA
Enumeration date
03/01/2007
Last updated
04/01/2008
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