| Name: | Poole Urology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Merged |
| Date of registration: | 10 Mar 2004 (21 years ago) |
| Entity Number: | 000-234-018 |
| Register Number: | 000234018 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 3500 WESTCHESTER RDBIRMINGHAM, AL 35223 |
| Registered Office Street Address ZIP Code: | 35223 |
| Authorized Capital: | $10 |
Activities
UROLOGY MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043360605 | 2007-01-12 | 2020-08-22 | 2018 BROOKWOOD MEDICAL CENTER DRIVE, SUITE 302, BIRMINGHAM, AL, 352096870, US | 2018 BROOKWOOD MEDICAL CENTER DRIVE, SUITE 302, BIRMINGHAM, AL, 352096870, US | |||||||||||||||||||||||||
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| Phone | +1 205-877-2935 |
| Fax | 2058701759 |
Authorized person
| Name | DR. BRYANT EMORY POOLE |
| Role | PRESIDENT |
| Phone | 2058772935 |
Taxonomy
| Taxonomy Code | 208800000X - Urology Physician |
| License Number | 18517 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 00009914615 |
| State | AL |
| Name | Role |
|---|---|
| POOLE, BRYANT EMORY | Agent |
| Name | Role |
|---|---|
| POOLE, BRYANT EMORY | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
