| Name: | Gastroenterologists Consultants of Jasper, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 08 May 2003 (22 years ago) (Companies founded in May 2003) |
| Entity Number: | 000-228-923 |
| Register Number: | 000228923 |
| ZIP code: | 35501 (Companies in Walker, 35501) |
| County: | Walker |
| Place of Formation: | Walker County |
| Registered Office Street Address: | 3400 HWY 78 E STE 410JASPER, AL 35501 |
| Authorized Capital: | $50 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053431924 | 2007-04-01 | 2014-11-19 | PO BOX 391, JASPER, AL, 355020391, US | 3400 HIGHWAY 78 E, MEDICAL ARTS TOWER SUITE 504, JASPER, AL, 355018907, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-295-9630 |
| Fax | 2052959362 |
| Fax | 2052969362 |
Authorized person
| Name | DR. LUIS R DAVILA |
| Role | PRESIDENT |
| Phone | 2052959630 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| License Number | 25227 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051553611DAV |
| State | AL |
| Issuer | BSBC |
| Number | 515-15424 |
| State | AL |
| Name | Role |
|---|---|
| DAVILA, LUIS R | Agent |
| Name | Role | Address |
|---|---|---|
| POOL, JAMES M | Incorporator | 1901 SIXTH AVENUE NORTH/2400 REGIONSBIRMINGHAM, AL 35203-2618 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
