| Name: | Heart Group of the Eastern Shore P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 13 Feb 2006 (19 years ago) |
| Entity Number: | 000-245-737 |
| Register Number: | 000245737 |
| Historical Names: |
Michael S. Pursley, M.D., P.C.
|
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 188 HOSPITAL DRFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Principal Address: | FAIRHOPE, AL |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE/CARDIOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609095157 | 2007-04-24 | 2013-12-09 | PO BOX 850266, MOBILE, AL, 366850266, US | 150 S. INGLESIDE STREET, #4 MEDICAL PARK, FAIRHOPE, AL, 365321804, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-990-1920 |
| Fax | 2519901921 |
Authorized person
| Name | DR. MICHAEL S PURSLEY |
| Role | PRESIDENT/OWNER |
| Phone | 2519901920 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 25610 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009936436 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009936467 |
| State | AL |
| Issuer | GRP NPI |
| Number | 1609095157 |
| State | AL |
| Issuer | BC/MC |
| Number | 51503479 |
| State | AL |
| Issuer | RR MEDICARE FOR GROUP |
| Number | DE4413 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009936433 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051554382 |
| State | AL |
| Issuer | MEDICAID |
| Number | 05538519 |
| State | MS |
| Issuer | NPI |
| Number | 1467430777 |
| State | AL |
| Issuer | BRAND NPI |
| Number | 1689678674 |
| State | AL |
| Issuer | MEDICARE GRP |
| Number | K814 |
| State | AL |
| Issuer | GRP MEDICAID |
| Number | 529927690 |
| State | AL |
| Issuer | MEDICARE BRAND |
| Number | 51541652 |
| State | AL |
| Issuer | RR MEDICARE |
| Number | P00082012 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009936434 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HEART GROUP OF THE EASTERN SHORE, P.C. 401(K) PLAN | 2014 | 204296906 | 2015-07-31 | HEART GROUP OF THE EASTERN SHORE, P.C. | 10 | |||||||||||||||||||||
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| HEART GROUP OF THE EASTERN SHORE, P.C. 401(K) PLAN | 2013 | 204296906 | 2014-06-02 | HEART GROUP OF THE EASTERN SHORE, P.C. | 8 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-06-02 |
| Name of individual signing | DIANE HEBERT |
| Name | Role |
|---|---|
| PURSLEY, MICHAEL S | Agent |
| Name | Role |
|---|---|
| PURSLEY, MICHAEL S | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2006-09-08 | Name Change | Michael S. Pursley, M.D., P.C. | Heart Group of the Eastern Shore P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
