| Name: | Jasper Podiatry Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 21 Aug 2003 (21 years ago) (Companies founded in August 2003) |
| Entity Number: | 000-230-659 |
| Register Number: | 000230659 |
| ZIP code: | 35501 (Companies in Walker, 35501) |
| County: | Walker |
| Place of Formation: | Walker County |
| Principal Address: | JASPER, AL |
| Registered Office Street Address: | 1800 BIRMINGHAM AVEJASPER, AL 35501 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PODIATRIC MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558556225 | 2007-09-06 | 2023-10-06 | 804 20TH AVE E, JASPER, AL, 355014024, US | 1800 BIRMINGHAM AVE, JASPER, AL, 355015461, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Fax | 2053844588 |
| Phone | +1 205-384-4474 |
| Fax | 2053844428 |
Authorized person
| Name | DR. JOHN S ODLE |
| Role | CHAIRMAN |
| Phone | 2059244474 |
Taxonomy
| Taxonomy Code | 261QP1100X - Podiatric Clinic/Center |
| License Number | 157 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | 480034067 |
| State | AL |
| Issuer | UPIN |
| Number | U58040 |
| State | AL |
| Issuer | BLUE CROSS AND BLUE SHIELD OF ALABAMA |
| Number | 051176296 |
| State | AL |
| Issuer | LICENSE NUMBER |
| Number | 157 |
| State | AL |
| Name | Role |
|---|---|
| ODLE, JOHN | Agent |
| Name | Role |
|---|---|
| ODLE, JOHN | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
