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Huntsville Neurology Center, P.C.

Details

Name: Huntsville Neurology Center, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 03 Jan 2005 (20 years ago)
Date of dissolution: 29 Apr 2013
Entity Number: 000-238-992
Register Number: 000238992
County: Madison
Place of Formation: Madison County
Principal Address: HUNTSVILLE, AL
Registered Office Street Address: 2350 WHITESBURG DRHUNTSVILLE, AL 35801
Registered Office Street Address ZIP Code: 35801
Authorized Capital: $1,000

Activities PRACTICE NEUROLOGICAL MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1417090366 2007-02-14 2020-08-22 2350 WHITESBURG DR S, HUNTSVILLE, AL, 358013818, US 2350 WHITESBURG DR S, HUNTSVILLE, AL, 358013818, US

Contacts

Phone +1 256-258-0052

Authorized person

Name MR. RAVI YANAMADULA
Role OFFICE MANAGER
Phone 2562580052

Taxonomy

Taxonomy Code 2084N0400X - Neurology Physician
License Number 00022841
State AL
Is Primary Yes

Other Provider Identifiers

Issuer BLUE CROSS BLUE SHEILD
Number 51002898
State AL

Agent

Name Role
NUTHI, USHA Agent

Incorporator

Name Role
NUTHI, USHA Incorporator

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State