| Name: | Kitti K. Outlaw, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 15 Oct 2003 (21 years ago) |
| Entity Number: | 000-231-499 |
| Register Number: | 000231499 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 3290 DAUPHIN ST STE 204MOBILE, AL 36606 |
| Registered Office Street Address ZIP Code: | 36606 |
| Authorized Capital: | $100 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356538961 | 2007-09-27 | 2019-03-04 | 3715 DAUPHIN ST STE 6A, MOBILE, AL, 366081774, US | 3715 DAUPHIN ST STE 6A, MOBILE, AL, 366081774, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-414-1333 |
| Fax | 2514143006 |
Authorized person
| Name | DR. KITTI K OUTLAW |
| Role | PRESIDENT OWNER |
| Phone | 2514141333 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| License Number | 00018171 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | HEALTHSPRING |
| Number | 46679 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 051519924 |
| State | AL |
| Issuer | UNITEDHEALTH CARE |
| Number | 1710551 |
| Issuer | AETNA |
| Number | 0005234470 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009937160 |
| State | AL |
| Issuer | SECURE HORIZONS |
| Number | 1310551 |
| State | AL |
| Name | Role |
|---|---|
| OUTLAW, KITTI K | Agent |
| Name | Role |
|---|---|
| OLMSTEAD, CRAIG | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
