| 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 | |||||||||||||||||||||||
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| 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
