Provider Demographics
NPI:1548041353
Name:OURTH, ALEX NAGEL
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:NAGEL
Last Name:OURTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOWEN
Mailing Address - State:IL
Mailing Address - Zip Code:62316-1130
Mailing Address - Country:US
Mailing Address - Phone:217-842-5211
Mailing Address - Fax:217-842-5202
Practice Address - Street 1:209 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BOWEN
Practice Address - State:IL
Practice Address - Zip Code:62316-1130
Practice Address - Country:US
Practice Address - Phone:217-842-5211
Practice Address - Fax:217-842-5202
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant