| Name: | Decatur ENT Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 20 Jul 1990 (34 years ago) (Companies founded in July 1990) |
| Entity Number: | 000-138-158 |
| Register Number: | 000138158 |
| ZIP code: | 35601 (Companies in Morgan, 35601) |
| County: | Morgan |
| Place of Formation: | Morgan County |
| Registered Office Street Address: | 1303 13TH AVENUE S EDECATUR, AL 35601 |
| Authorized Capital: | $1,000 |
Activities
REAL OR PERSONAL PROPERTY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164487708 | 2006-04-18 | 2023-02-20 | 1218 13TH AVE SE, DECATUR, AL, 356014307, US | 1218 13TH AVE SE, DECATUR, AL, 356014307, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 256-355-6200 |
| Fax | 2563556241 |
Authorized person
| Name | SHONDRA CLARK |
| Role | BILLING/INSURANCE |
| Phone | 2563556200 |
Taxonomy
| Taxonomy Code | 207YS0123X - Facial Plastic Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 207YX0602X - Otolaryngic Allergy Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS OF AL GROUP# |
| Number | D380 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529001940 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | CM6320 |
| State | AL |
| Name | Role |
|---|---|
| COPELAND, SAGE KINNEY | Agent |
| Name | Role |
|---|---|
| COPELAND, SAGE KINNEY | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
