| Name: | DIEGMANN AND HENDERSON OBGYN, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 19 Oct 2006 (18 years ago) |
| Entity Number: | 000-249-821 |
| Register Number: | 000249821 |
| Historical Names: |
DIEGMANN OBGYN P.C.
|
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | 150 SOUTH INGLESIDE STREET NUMBER 2FAIRHOPE, AL 36532 |
| Principal Address ZIP Code: | 36532 |
| Registered Office Street Address: | 2 MEDICAL PARK DRIVEFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649367228 | 2006-10-06 | 2024-07-02 | 2 MEDICAL PARK, FAIRHOPE, AL, 365321804, US | 2 MEDICAL PARK, FAIRHOPE, AL, 365321804, US | |||||||||||||||||||||||||
|
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| Phone | +1 251-990-6550 |
| Fax | 2519906552 |
Authorized person
| Name | BRET HENDERSON |
| Role | PRESIDENT |
| Phone | 2515218394 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| License Number | 000001748 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529930680 |
| State | AL |
| Name | Role |
|---|---|
| HENDERSON, BRET T. | Agent |
| Name | Role | Address |
|---|---|---|
| DIEGMANN, FRED F | Incorporator | 188 HOSPITAL DR STE 102FAIRHOPE, AL 36532 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2015-06-26 | Name Change | DIEGMANN OBGYN P.C. | DIEGMANN AND HENDERSON OBGYN, P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
