| Name: | Magnolia Commons Pediatrics, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 27 Sep 2011 (13 years ago) |
| Entity Number: | 000-026-365 |
| Register Number: | 000026365 |
| County: | Elmore |
| Place of Formation: | Elmore County |
| Principal Address: | 500 HOSPITAL DRWETUMPKA, AL 36092 |
| Principal Address ZIP Code: | 36092 |
Activities
PROVIDE HEALTH CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013280486 | 2012-02-16 | 2012-02-16 | 78 CAMBRIDGE CT, WETUMPKA, AL, 360931259, US | 78 CAMBRIDGE CT, WETUMPKA, AL, 360931259, US | |||||||||||||||||||||||
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| Phone | +1 334-567-6915 |
| Fax | 3345147269 |
| Phone | +1 334-567-4311 |
| Fax | 3345674312 |
Authorized person
| Name | MICHAEL D BRUCE |
| Role | CEO |
| Phone | 3345674311 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| License Number | 19637 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRUCE, MICHAEL D | Organizer | 500 HOSPITAL DRIVEWETUMPKA, AL 36092 |
| Name | Role | Address |
|---|---|---|
| BRUCE, MICHAEL D | Agent | 500 HOSPITAL DRIVEWETUMPKA, AL 36092 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
