| Name: | Eastern Shore Ear, Nose & Throat Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Oct 1987 (37 years ago) |
| Entity Number: | 000-119-889 |
| Register Number: | 000119889 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | 188 HOSPITAL DR STE 101FAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | $25,000 |
| Paid Share Capital: | $25,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386707339 | 2006-12-19 | 2023-11-30 | 8096 TWIN BEECH RD UNIT 102, FAIRHOPE, AL, 365327195, US | 8096 TWIN BEECH RD UNIT 102, FAIRHOPE, AL, 365327195, US | |||||||||||||||||||||
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| Phone | +1 251-928-0300 |
| Fax | 2519901898 |
Authorized person
| Name | DR. WILLIAM B NORRIS |
| Role | PRESIDENT |
| Phone | 2519280300 |
Taxonomy
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528501890 |
| State | AL |
| Name | Role |
|---|---|
| NORRIS, WILLIAM B | Agent |
| Name | Role |
|---|---|
| NORRIS, WILLIAM B | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
