| Name: | Birmingham Minimally Invasive Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 05 May 2006 (19 years ago) |
| Entity Number: | 000-247-168 |
| Register Number: | 000247168 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 48 MEDICAL PARK EAST DR STE 150BIRMINGHAM, AL 35235 |
| Registered Office Street Address ZIP Code: | 35235 |
| Principal Address: | BIRMINGHAM, AL |
| Authorized Capital: | $5,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164467817 | 2006-06-17 | 2008-05-09 | 48 MEDICAL PARK EAST DR, STE 150, BIRMINGHAM, AL, 35235, US | 48 MEDICAL PARK EAST DR, STE 150, BIRMINGHAM, AL, 35235, US | |||||||||||||||||||||||||||
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| Phone | +1 205-833-6907 |
| Fax | 2058336987 |
Authorized person
| Name | JAY CHARLES LONG |
| Role | OWNER GENERAL SURGEON |
| Phone | 2058336907 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529928520 |
| State | AL |
| Issuer | BCBS |
| Number | 051003774 |
| State | AL |
| Name | Role |
|---|---|
| LONG, JAY C | Agent |
| Name | Role | Address |
|---|---|---|
| LEVITT, RONALD A | Incorporator | PO BOX 55727BIRMINGHAM, AL 35255-5727 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
