| Name: | Medical Center Otolaryngology Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 29 Dec 1988 (36 years ago) |
| Entity Number: | 000-128-079 |
| Register Number: | 000128079 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 1527 5TH AVE N STE 260BIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
| Authorized Capital: | $1,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275768178 | 2009-05-20 | 2009-05-20 | 1527 5TH AVE N, SUITE 260, BIRMINGHAM, AL, 352031854, US | 1527 5TH AVE N, SUITE 260, BIRMINGHAM, AL, 352031854, US | |||||||||||||||||||||||||
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| Phone | +1 205-458-0008 |
| Fax | 2054580011 |
Authorized person
| Name | RICHARD A. WALKER |
| Role | PRESIDENT |
| Phone | 2054580008 |
Taxonomy
| Taxonomy Code | 207YX0602X - Otolaryngic Allergy Physician |
| License Number | 08026 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000010614 |
| State | AL |
| Name | Role |
|---|---|
| WALKER, RICHARD A | Agent |
| Name | Role |
|---|---|
| WALKER, RICHARD A MD | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
