| Name: | CROSEN MEDICAL, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 21 Feb 2012 (13 years ago) |
| Entity Number: | 000-042-035 |
| Register Number: | 000042035 |
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Principal Address: | 320 SNOW STREET SUITE AOXFORD, AL 36203 |
| Principal Address ZIP Code: | 36203 |
Activities
PERFORM OUTPATIENT MEDICAL CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891110540 | 2014-03-04 | 2022-08-08 | 1011 LEIGHTON AVE, ANNISTON, AL, 362075701, US | 1011 LEIGHTON AVE, ANNISTON, AL, 362075701, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 256-770-7197 |
| Fax | 2564054439 |
Authorized person
| Name | MARGARET S PORTER |
| Role | OFFICE MANAGER/ AUTHORIZED OFFICIAL |
| Phone | 2567707197 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 19946 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051554151 |
| State | AL |
| Issuer | MEDICAID |
| Number | 1700811072 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CROSEN, KANINA | Organizer | 320 SNOW STREET SUITE AOXFORD, AL 36203 |
| CROSEN, ZACH | Organizer | 320 SNOW STREET SUITE AOXFORD, AL 36203 |
| Name | Role | Address |
|---|---|---|
| CROSEN, ZACH | Agent | 320 SNOW STREET SUITE AOXFORD, AL 36203 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
