Name: | CRNA SERVICES OF ST. VINCENT'S EAST, LLC |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Dissolved |
Date of registration: | 20 Jun 2012 (12 years ago) |
Date of dissolution: | 01 Aug 2017 |
Entity Number: | 000-064-762 |
Register Number: | 000064762 |
County: | Montgomery |
Place of Formation: | Jefferson County |
Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
Registered Office Street Address ZIP Code: | 36104 |
Activities
PROVIDE HEALTHCARE SERVICES
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1346505336 | 2012-07-06 | 2014-08-08 | PO BOX 935535, ATLANTA, GA, 311935529, US | 50 MEDICAL PARK DR E, BIRMINGHAM, AL, 352353401, US | |||||||||||||||||||||||
|
Phone | +1 205-979-5882 |
Fax | 2059791248 |
Phone | +1 205-838-3000 |
Authorized person
Name | MRS. JENNIFER L KINGRY |
Role | VP OF FINANCIAL REPORTING |
Phone | 2058383766 |
Taxonomy
Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 140624 |
State | AL |
Name | Role | Address |
---|---|---|
CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Name | Role | Address |
---|---|---|
ST. VINCENT'S EAST | Organizer | 810 ST VINCENT'S DR 3RD FLOOR POB IBIRMINGHAM, AL 35205 |
DOUGHTON, SUSAN D | Organizer | 1130 22ND ST S, RIDGE PARK STE 4000BIRMINGHAM, AL 35205 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State