| Name: | Decatur Maxillofacial and Cosmetic Surgery Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 01 Jul 1996 (28 years ago) (Companies founded in July 1996) |
| Entity Number: | 000-180-728 |
| Register Number: | 000180728 |
| ZIP code: | 35601 (Companies in Morgan, 35601) |
| County: | Morgan |
| Place of Formation: | Morgan County |
| Principal Address: | DECATUR, AL |
| Registered Office Street Address: | 1318 STRATFORD RD SEDECATUR, AL 35601 |
| Authorized Capital: | $10,000 |
| Paid Share Capital: | $1,000 |
Activities
PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831360601 | 2008-03-19 | 2008-03-19 | 2023 DANVILLE PARK DR SW, DECATUR, AL, 356031833, US | 2023 DANVILLE PARK DR SW, DECATUR, AL, 356031833, US | |||||||||||||||||||||||||||
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| Phone | +1 256-355-8224 |
| Fax | 2563558819 |
Authorized person
| Name | DR. WILLIAM F LITTLEJOHN JR. |
| Role | PRESIDENT |
| Phone | 2563558224 |
Taxonomy
| Taxonomy Code | 204E00000X - Oral & Maxillofacial Surgery (D.M.D.) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 000026618 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529700210 |
| State | AL |
| Name | Role |
|---|---|
| LITTLEJOHN, WILLIAM F JR | Agent |
| Name | Role |
|---|---|
| LITTLEJOHN, WILLIAM F JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
