| Name: | Shoals Hearing Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 13 Apr 1999 (26 years ago) |
| Entity Number: | 000-202-174 |
| Register Number: | 000202174 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Principal Address: | FLORENCE, AL |
| Registered Office Street Address: | 205 S SEMINARY ST STE 117/118FLORENCE, AL 35630 |
| Registered Office Street Address ZIP Code: | 35630 |
| Authorized Capital: | $1,000 |
Activities
AUDIOLOGY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568589034 | 2007-03-22 | 2016-10-26 | 433 N PINE ST, FLORENCE, AL, 356304654, US | 433 N PINE ST, FLORENCE, AL, 356304654, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-740-8383 |
| Fax | 2567408386 |
Authorized person
| Name | DR. RICHARD LEE GRESHAM |
| Role | PRESIDENT |
| Phone | 2567408383 |
Taxonomy
| Taxonomy Code | 231H00000X - Audiologist |
| License Number | 587-A |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009905080 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009907280 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529901740 |
| State | AL |
| Name | Role |
|---|---|
| GRESHAM, RICHARD LEE | Agent |
| Name | Role |
|---|---|
| GRESHAM, RICHARD LEE | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
