| Name: | Critical Care Pediatrics, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 13 Dec 1999 (25 years ago) |
| Date of dissolution: | 19 Dec 2011 |
| Entity Number: | 000-206-681 |
| Register Number: | 000206681 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 2314 WOODCLIFF RDHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | $10 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316005481 | 2006-12-04 | 2020-08-22 | PO BOX 2856, HUNTSVILLE, AL, 358042856, US | 911 BIG COVE RD SE, HUNTSVILLE, AL, 358013750, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-656-5789 |
| Phone | +1 256-265-7946 |
Authorized person
| Name | MRS. TONJA M WILLIAMS |
| Role | OFFICE MANAGER |
| Phone | 2566565789 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| License Number | 22150 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 2080P0203X - Pediatric Critical Care Medicine Physician |
| License Number | 20693 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 2080P0203X - Pediatric Critical Care Medicine Physician |
| License Number | 22150 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51093653 |
| State | AL |
| Issuer | BCBS |
| Number | 51092779 |
| State | AL |
| Name | Role |
|---|---|
| MCDUFFEE, ALICE T | Agent |
| Name | Role |
|---|---|
| MCDUFFEE, ALICE T | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
