| Name: | Chelsea Pediatrics, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 01 Mar 2004 (21 years ago) |
| Date of dissolution: | 18 Sep 2018 |
| Entity Number: | 000-233-940 |
| Register Number: | 000233940 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 3305 BUCK HORN COVEBIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Authorized Capital: | 30 |
Activities
GENERAL PEDIATRIC PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669643789 | 2008-03-17 | 2008-03-17 | 194 NARROWS DR, SUITE 104, BIRMINGHAM, AL, 352428667, US | 194 NARROWS DR, SUITE 104, BIRMINGHAM, AL, 352428667, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-981-2728 |
| Fax | 2059812729 |
Authorized person
| Name | DR. ALICE M HARDY |
| Role | OWNER |
| Phone | 2059812728 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 25409 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51519854 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529918920 |
| State | AL |
| Name | Role |
|---|---|
| CHEN, SUSAN | Incorporator |
| Name | Role |
|---|---|
| HARDY, ALICE M | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
