| Name: | Gastroenterology Associates West, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Jul 1986 (38 years ago) |
| Entity Number: | 000-111-546 |
| Register Number: | 000111546 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 817 PRINCETON AVE SWBIRMINGHAM, AL 35211 |
| Registered Office Street Address ZIP Code: | 35211 |
| Authorized Capital: | $3,000 |
| Paid Share Capital: | $1,000 |
Activities
GASTROENTEROLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659506004 | 2009-05-28 | 2009-05-28 | 833 PRINCETON AVE SW, SUITE 200D, BIRMINGHAM, AL, 352111323, US | 833 PRINCETON AVE SW, SUITE 200D, BIRMINGHAM, AL, 352111323, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 205-786-5527 |
| Fax | 2057865529 |
Authorized person
| Name | DR. JACK L. MAULDIN |
| Role | PRESIDENT |
| Phone | 2057865527 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | 6455 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000004027 |
| State | AL |
| Name | Role |
|---|---|
| GASTROENTEROLOGY ASSOCIATES EAST PC | Incorporator |
| Name | Role |
|---|---|
| MAULDIN, JACK L | Agent |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
