| Name: | Eastern Medical Specialists, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 05 Nov 1992 (32 years ago) (Companies founded in November 1992) |
| Entity Number: | 000-152-973 |
| Register Number: | 000152973 |
| Historical Names: |
Eastern Medical Group, P.C.
|
| ZIP code: | 35235 (Companies in Jefferson, 35235) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 48 MEDICAL PARK EAST DR ST 354BIRMINGHAM, AL 35235 |
| Authorized Capital: | $2,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376710681 | 2008-05-15 | 2008-05-15 | 48 MEDICAL PARK DR E, BIRMINGHAM, AL, 352353400, US | 150 GILBREATH DR, ONEONTA, AL, 351212827, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-949-4446 |
| Fax | 2058383206 |
| Phone | +1 205-274-3344 |
Authorized person
| Name | MICHELLE P RONK |
| Role | ADMINISTRATOR |
| Phone | 2059494446 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | 10881 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009972390 |
| State | AL |
| Issuer | BLUE CROSS |
| Number | 51503246 |
| State | AL |
| Name | Role |
|---|---|
| LAWRENCE, MARCUS S | Agent |
| Name | Role | Address |
|---|---|---|
| KOLB, THOMAS O | Incorporator | 420 NORTH 20TH STREET SUITE 1400BIRMINGHAM, AL 35223 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1992-11-13 | Name Change | Eastern Medical Group, P.C. | Eastern Medical Specialists, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
