| Name: | Birmingham Pain Management & Rehabilitation Centers, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 09 Sep 2002 (22 years ago) (Companies founded in September 2002) |
| Date of dissolution: | 17 Jan 2023 |
| Entity Number: | 000-224-982 |
| Register Number: | 000224982 |
| ZIP code: | 35211 (Companies in Jefferson, 35211) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 801 PRINCETON AVE SW STE 201BIRMINGHAM, AL 35211 |
| Registered Office Mailing Address: | POB-1BIRMINGHAM, AL 35211 |
| Authorized Capital: | $1,000 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841352929 | 2006-12-14 | 2013-10-18 | 801 PRINCETON AVENUE SW, POB I SUITE 201, BIRMINGHAM, AL, 352111310, US | 801 PRINCETON AVE SW, POB I SUITE 201, BIRMINGHAM, AL, 352111310, US | |||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 205-783-7705 |
| Fax | 2057837706 |
Authorized person
| Name | EDWIN L KELSEY |
| Role | OWNER |
| Phone | 2057837705 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | 16871 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | 16871 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1932016895 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529914300 |
| State | AL |
| Name | Role |
|---|---|
| KELSEY, EDWIN L | Agent |
| Name | Role |
|---|---|
| KELSEY, EDWIN L | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
