| Name: | Lakeshore Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 23 Oct 1991 (33 years ago) |
| Entity Number: | 000-145-854 |
| Register Number: | 000145854 |
| County: | Barbour |
| Place of Formation: | Barbour County |
| Principal Address: | EUFAULA, AL |
| Registered Office Street Address: | 810 W WASHINGTON STEUFAULA, AL 36027 |
| Registered Office Street Address ZIP Code: | 36027 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346428331 | 2008-02-01 | 2008-02-01 | 1026 S EUFAULA AVE, EUFAULA, AL, 360272702, US | 1026 S EUFAULA AVE, EUFAULA, AL, 360272702, US | |||||||||||||||||||
|
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| Phone | +1 334-687-5775 |
| Fax | 3346875095 |
Authorized person
| Name | DR. GERTRUDE E NIXON |
| Role | PHYSICIAN/OWNER |
| Phone | 3346875775 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 16148 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| NIXON, GERTRUDE E MD | Agent |
| Name | Role |
|---|---|
| NIXON, GERTRUDE E MD | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
