| Name: | Eich Plastic Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 Nov 2001 (23 years ago) |
| Entity Number: | 000-219-652 |
| Register Number: | 000219652 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2230 THIRD AVE NORTHBIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE PROFESSIONAL MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508856352 | 2005-10-24 | 2010-01-19 | 200 PILOT MEDICAL DRIVE, SUITE 100, BIRMINGHAM, AL, 352353462, US | 200 PILOT MEDICAL DRIVE, SUITE 100, BIRMINGHAM, AL, 352353462, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-856-6155 |
| Fax | 2058569391 |
Authorized person
| Name | MR. BRUCE SHELBY EICH II |
| Role | PRESIDENT |
| Phone | 2058566155 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | 17710 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009975650 |
| State | AL |
| Issuer | VIVA |
| Number | F78813 |
| Issuer | THE OATH |
| Number | 43438 |
| Issuer | BC |
| Number | 51505077 |
| Issuer | UNITED HEALTH CARE |
| Number | 1310081 |
| Name | Role |
|---|---|
| EICH, BRUCE SHELBY II | Agent |
| Name | Role |
|---|---|
| EICH, BRUCE SHELBY II | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
