MR. LUCILLOUS P ALEXANDER P.A.
NPI 1215228119
Physician Assistant - Medical in Longview, TX

Q: What is Lucillous Alexander's NPI number?

The NPI number for Lucillous Alexander is 1215228119. It was assigned to this individual provider in the NPPES registry on April 26, 2011.

Q: What is Lucillous Alexander's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Active since April 26, 2011PECOS Enrolled

1207A E MARSHALL AVE, LONGVIEW, TX 75601(903) 907-7003 Get Directions Write a Review

NPPES record last updated: May 10, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 10, 2023, Nov 22, 2019, Feb 15, 2017 (3 updates tracked since 2017).

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About Mr. Lucillous P Alexander P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. LUCILLOUS P ALEXANDER P.A. (NPI 1215228119) is an individual medical provider in Longview, Texas, licensed in Texas (PA06875) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1215228119

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameMR. LUCILLOUS P ALEXANDERCredential: P.A.

Location Address1207A E MARSHALL AVELongview, TX 75601-5604

Mailing AddressPo Box 746079Atlanta, GA 30374-6079 · Fax (312) 929-0373

Phone(903) 907-7003

Sole ProprietorYes

Enumeration DateApril 26, 2011

Last NPPES UpdateMay 10, 20233 updates tracked since enumeration

NPPES CertifiedMay 10, 2023

✔ NPI 1215228119 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in TX · PA06875

1207A E MARSHALL AVE, Longview, TX 75601

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Lucillous P Alexander P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. RENEE ELIZABETH ERNST NP-C

Nurse Practitioner (Primary Care)