| Name: | East Alabama Arthritis Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 21 Sep 2000 (24 years ago) |
| Entity Number: | 000-212-138 |
| Register Number: | 000212138 |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | AUBURN, AL |
| Registered Office Street Address: | 2260 EAST UNIVERSITY AVE APT 15-HAUBURN, AL 36830 |
| Registered Office Street Address ZIP Code: | 36830 |
| Authorized Capital: | $10,000 |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE OF MEDICINE SPECIALIZING IN RHEUMATOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326220351 | 2007-11-30 | 2019-02-06 | 1536 PROFESSIONAL PKWY, AUBURN, AL, 368302857, US | 1536 PROFESSIONAL PKWY, AUBURN, AL, 368302857, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-501-4424 |
| Fax | 3345011223 |
Authorized person
| Name | SUSAN WOOD |
| Role | BILLING MANAGER |
| Phone | 3345014424 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | 00023033 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529906060 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009943130 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51098534 |
| State | AL |
| Name | Role |
|---|---|
| ESTRADA, ADAHLI | Agent |
| Name | Role |
|---|---|
| ESTRADA, ADAHLI | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
