| Name: | Tennessee Valley Vascular Consultants P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Mar 2003 (22 years ago) |
| Date of dissolution: | 11 Dec 2013 |
| Entity Number: | 000-227-818 |
| Register Number: | 000227818 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 217 LONGWOOD DR SEHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | $2,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL CARE PRACTICE/VASCULAR DISEASE TREATMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780613059 | 2006-06-30 | 2008-06-06 | 420 LOWELL DR SE, SUITE 500, HUNTSVILLE, AL, 358013754, US | 420 LOWELL DR SE, SUITE 500, HUNTSVILLE, AL, 358013754, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-265-7480 |
| Fax | 2562657481 |
Authorized person
| Name | FRED S STUCKY III |
| Role | PRESIDENT |
| Phone | 2562657480 |
Taxonomy
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | 0008023 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | 00016783 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 2086S0129X - Vascular Surgery Physician |
| License Number | 00017567 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51514735STU |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51514734JOH |
| State | AL |
| Issuer | MEDICARE RAILROAD |
| Number | P00000016 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051514735 |
| State | AL |
| Issuer | AETNA |
| Number | 0005683727 |
| Issuer | MEDICAID |
| Number | 051514734 |
| State | AL |
| Issuer | MEDICARE RAILROAD |
| Number | P00000018 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051514736 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51514736LOW |
| State | AL |
| Issuer | MEDICARE RAILROAD |
| Number | P00000017 |
| State | AL |
| Issuer | AETNA |
| Number | 0004070317 |
| Issuer | AETNA |
| Number | 0005999121 |
| Name | Role |
|---|---|
| STUCKY, FRED S III | Agent |
| Name | Role | Address |
|---|---|---|
| STUCKY, FRED S III | Incorporator | No data |
| LOWERY, TRACY A | Incorporator | No data |
| JOHNSON, RONNY C | Incorporator | 612 HOLMES AVENUEHUNTSVILLE, AL 35801 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
