Name: | North East Alabama Center for Infectious Disease & Internal Medicine, P.C. |
Jurisdiction: | Alabama |
Legal type: | Domestic Professional Corporation |
Status: | Exists |
Date of registration: | 08 Oct 1999 (25 years ago) |
Entity Number: | 000-205-708 |
Register Number: | 000205708 |
County: | Etowah |
Place of Formation: | Etowah County |
Registered Office Street Address: | 207 EAST GRAND AVERAINBOW CITY, AL 35906 |
Registered Office Street Address ZIP Code: | 35906 |
Authorized Capital: | 1,000 |
Activities
MEDICAL PRACTICE
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1225159981 | 2007-04-02 | 2010-12-06 | PO BOX 1364, GADSDEN, AL, 359021364, US | 107 MAIN ST, COLLINSVILLE, AL, 35961, US | |||||||||||||||||||||||||||||||||||
|
Phone | +1 256-442-7594 |
Fax | 2564427594 |
Phone | +1 256-524-4788 |
Fax | 2565244788 |
Authorized person
Name | DR. SUNIL K JAISWAL |
Role | CEO |
Phone | 2564427594 |
Taxonomy
Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
License Number | 22810 |
State | AL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 000094829 |
State | AL |
Issuer | MEDICAID |
Number | 000060252 |
State | AL |
Name | Role |
---|---|
JAISWAL, SUNIL K | Agent |
Name | Role |
---|---|
GORDON, JOHN | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State