| Name: | Dialysis Affiliates of South Alabama, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 19 Nov 1993 (31 years ago) |
| Date of dissolution: | 20 Mar 2014 |
| Entity Number: | 000-160-443 |
| Register Number: | 000160443 |
| County: | Escambia |
| Place of Formation: | Escambia County |
| Principal Address: | BREWTON, AL |
| Registered Office Street Address: | 1205 BELLEVILLE AVEBREWTON, AL 36426 |
| Registered Office Street Address ZIP Code: | 36426 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
ALL ASPECTS OF AN END STAGE RENAL DISEASE TREATMENT/TRANSPLANT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932181278 | 2005-11-14 | 2011-04-29 | 1205 BELLEVILLE AVE, BREWTON, AL, 364261304, US | 1205 BELLEVILLE AVE, BREWTON, AL, 364261304, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 251-867-3650 |
| Fax | 2518673610 |
Authorized person
| Name | DR. JAMES D. RAULERSON |
| Role | CEO |
| Phone | 2518673650 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | 10749 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | DIA2549D |
| State | AL |
| Issuer | BC/BS OF ALABAMA |
| Number | 264DAS |
| State | AL |
| Name | Role |
|---|---|
| RAULERSON, J DANIEL | Agent |
| Name | Role |
|---|---|
| RAULERSON, J DANIEL | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
