| 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 | |||||||||||||||||||||||||||||||||||
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| 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
