| Name: | Katharine R. Cooper, M.D.,PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 23 Aug 2000 (24 years ago) |
| Entity Number: | 000-211-662 |
| Register Number: | 000211662 |
| County: | Tallapoosa |
| Place of Formation: | Tallapoosa County |
| Registered Office Street Address: | 3368 HWY 280 MEDICAL PARK PROFESSIONAL BLDG STE280ALEXANDER CITY, AL 35010 |
| Registered Office Street Address ZIP Code: | 35010 |
| Registered Office Mailing Address: | STE 205 MEDICAL PARK PROFESSIONAL BLDG 3368 HWY280ALEXANDER CITY, AL 35010 |
| Registered Office Mailing Address ZIP Code: | 35010 |
| Authorized Capital: | 1,000 NPV |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL SPECIALTY OF GYNECOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972594265 | 2005-11-04 | 2008-11-10 | 3368 HIGHWAY 280, SUITE 205, ALEXANDER CITY, AL, 350103393, US | 3368 HIGHWAY 280, SUITE 205, ALEXANDER CITY, AL, 350103393, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-234-2464 |
| Fax | 2562342440 |
Authorized person
| Name | KATHARINE R COOPER |
| Role | PRESIDENT |
| Phone | 2562342464 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 18123 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | ALABAMA BCBS ID # |
| Number | 98417 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009937370 |
| State | AL |
| Issuer | MEDICARE RAILROAD ID # |
| Number | 160051058 |
| State | AL |
| Name | Role |
|---|---|
| COOPER, KATHARINE R | Incorporator |
| Name | Role |
|---|---|
| COOPER, KATHARINE R | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
