| Name: | Magnolia Springs Pediatrics, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 04 Jan 1999 (26 years ago) |
| Entity Number: | 000-199-917 |
| Register Number: | 000199917 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | 14975 HIGHWAY 98MAGNOLIA SPRINGS, AL 36555 |
| Principal Address ZIP Code: | 36555 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427232776 | 2007-12-21 | 2007-12-21 | PO BOX 307, MAGNOLIA SPRINGS, AL, 365550307, US | 14975 HWY 98, MAGNOLIA SPRINGS, AL, 365550307, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 251-965-3320 |
| Fax | 2519653315 |
Authorized person
| Name | MRS. DIANA R MCKENZIE |
| Role | OFFICE MANAGER |
| Phone | 2519655088 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | MD7965 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | MD27137 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | ROBERT L RUX |
| Number | 009942429 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000008277 |
| State | AL |
| Name | Role |
|---|---|
| WALKER, A B | Agent |
| Name | Role |
|---|---|
| SWEET, JAMES H | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
