| Name: | Brookwood Ophthalmology Imaging & Ancillary Services, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 18 Feb 2005 (20 years ago) (Companies founded in February 2005) |
| Entity Number: | 000-239-894 |
| Register Number: | 000239894 |
| Historical Names: |
Brookwood Ophthalmology, Inc.
|
| ZIP code: | 35209 (Companies in Jefferson, 35209) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | ONE INDEPENDENCE PLAZA STE 810HOMEWOOD, AL 35209 |
| Authorized Capital: | 10 |
Activities
PHYSICIAN OPHTHALMOLOGY SERVICES
MEDICAL IMAGING/DIAGNOSTIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1386849669 | 2007-06-18 | 2023-05-11 | 1 CHASE CORPORATE DR STE 439, HOOVER, AL, 352441026, US | 1 CHASE CORPORATE DR STE 439, HOOVER, AL, 352441026, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-313-6300 |
| Fax | 2536454859 |
| Fax | 2534654859 |
Authorized person
| Name | MRS. JANIE NORFLEET WHITE |
| Role | PRESIDENT |
| Phone | 2053839498 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | No |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS MARION |
| Number | 51533857 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051533202 |
| State | AL |
| Issuer | BCBS AL BROOKWOOD |
| Number | 51533202 |
| State | AL |
| Issuer | MEDICARE RAILROAD |
| Number | P00301433 |
| State | AL |
| Issuer | AETNA |
| Number | 4648847 |
| State | AL |
| Issuer | VIVA |
| Number | A96597 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009936633 |
| State | AL |
| Issuer | TRICARE STANDARD HUMANA |
| Number | 213985282 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| WHITE, JANIE N | Agent | ONE INDEPENDENCE PLAZA SUITE 410HOMEWOOD, AL 35209 |
| Name | Role | Address |
|---|---|---|
| WHITE, JANIE N | Incorporator | ONE INDEPENDENCE PLAZA SUITE 410HOMEWOOD, AL 35209 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2014-02-04 | Name Change | Brookwood Ophthalmology, Inc. | Brookwood Ophthalmology Imaging & Ancillary Services, Inc. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
