Southern Cancer Center, P.C.

Details

Name:	Southern Cancer Center, P.C.
Jurisdiction:	Alabama
Legal type:	Domestic Professional Corporation
Status:	Exists
Date of registration:	22 Dec 2006 (18 years ago)
Entity Number:	000-250-384
Register Number:	000250384
County:	Baldwin
Place of Formation:	Mobile County
Principal Address:	MOBILE, AL
Registered Office Street Address:	29653 ANCHOR CROSS BLVDDAPHNE, AL 36526
Registered Office Street Address ZIP Code:	36526
Authorized Capital:	$10,000

Activities MEDICAL PRACTICE/ONCOLOGY

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1619215381

2013-01-30

2023-07-24

29653 ANCHOR CROSS BLVD, SUTIE A 101, DAPHNE, AL, 365269594, US

Contacts

Phone	+1 251-607-5061
Fax	2516075062

Authorized person

Name	LAUREN PETTIS
Role	EXECUTIVE DIRECTOR
Phone	2516256896

Taxonomy

Taxonomy Code	333600000X - Pharmacy
Is Primary	Yes
Taxonomy Code	3336C0003X - Community/Retail Pharmacy
Is Primary	No
Taxonomy Code	3336S0011X - Specialty Pharmacy
Is Primary	No

Other Provider Identifiers

Issuer	NCPDP PROVIDER IDENTIFICATION NUMBER
Number	0138455

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

SOUTHERN CANCER CENTER,PC.401(K) PLAN

2012

208097639

2013-09-10

SOUTHERN CANCER CENTER,P.C

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2007-03-03
Business code	621111
Sponsor’s telephone number	2516075016
Plan sponsor’s address	29653 ANCHOR CROSS BLVD., DAPHNE, AL, 36525

Signature of

Role	Plan administrator
Date	2013-09-10
Name of individual signing	ANNA HILEMAN

Agent

Name	Role
PETTIS, LAUREN R	Agent

Incorporator

Name	Role	Address
SHARP, THOMAS E III	Incorporator	11 NORTH WATER STREET, SUITE 24290MOBILE, AL 36602

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State