| Name: | Trussville Foot Care Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 15 Dec 1998 (26 years ago) |
| Date of dissolution: | 13 Jun 2014 |
| Entity Number: | 000-199-545 |
| Register Number: | 000199545 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | TRUSSVILLE, AL |
| Registered Office Street Address: | 1930 EDWARDS LAKE RDBIRMINGHAM, AL 35235 |
| Registered Office Street Address ZIP Code: | 35235 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE OF PODIATRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043456254 | 2008-12-18 | 2008-12-18 | 1930 EDWARDS LAKE RD, SUITE 138, BIRMINGHAM, AL, 352353718, US | 1930 EDWARDS LAKE RD, SUITE 138, BIRMINGHAM, AL, 352353718, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 205-661-1400 |
Authorized person
| Name | DAVID ANDERSON |
| Role | OWNER |
| Phone | 2056611400 |
Taxonomy
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | 209 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529906320 |
| State | AL |
| Name | Role |
|---|---|
| ANDERSON, DAVID Q | Agent |
| Name | Role |
|---|---|
| ANDERSON, DAVID QUENTIN | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
