| Name: | Lakeshore Pediatrics, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 04 Jun 1996 (28 years ago) (Companies founded in June 1996) |
| Entity Number: | 000-180-331 |
| Register Number: | 000180331 |
| ZIP code: | 35660 (Companies in Colbert, 35660) |
| County: | Colbert |
| Place of Formation: | Colbert County |
| Principal Address: | SHEFFIELD, AL |
| Registered Office Street Address: | 1120 S JACKSON HWY STE 204SHEFFIELD, AL 35660 |
| Authorized Capital: | $500 |
| Paid Share Capital: | $200 |
Activities
PEDIATRIC MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801238787 | 2013-07-22 | 2013-07-22 | 1120 S JACKSON HWY STE 304, SHEFFIELD, AL, 356605773, US | 12521 AL HIGHWAY 157 STE B, MOULTON, AL, 356501937, US | |||||||||||||||||||||||||
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| Phone | +1 256-386-4151 |
| Phone | +1 256-974-6300 |
Authorized person
| Name | AGUSTIN RIVAS |
| Role | OWNER |
| Phone | 2563864151 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| License Number | 17108 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1588002455 |
| State | AL |
| Name | Role |
|---|---|
| RIVAS, AGUSTIN G | Agent |
| Name | Role |
|---|---|
| RIVAS, AGUSTIN C | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
