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) (Companies founded in October 2003) |
Entity Number: | 000-231-499 |
Register Number: | 000231499 |
ZIP code: | 36606 (Companies in Mobile, 36606) |
County: | Mobile |
Place of Formation: | Mobile County |
Principal Address: | MOBILE, AL |
Registered Office Street Address: | 3290 DAUPHIN ST STE 204MOBILE, AL 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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