| Name: | Laboratory Acquisition Company, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Merged |
| Date of registration: | 12 Jul 2007 (17 years ago) |
| Entity Number: | 000-253-442 |
| Register Number: | 000253442 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2019 CLUBVIEW DRMONTGOMERY, AL 36106 |
| Registered Office Street Address ZIP Code: | 36106 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639379738 | 2007-07-18 | 2012-09-07 | 225B WINTON M BLOUNT LOOP, MONTGOMERY, AL, 361173507, US | 225B WINTON M BLOUNT LOOP, MONTGOMERY, AL, 361173507, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-263-6228 |
| Fax | 3342659136 |
Authorized person
| Name | MRS. JANICE BLEVINS |
| Role | OFFICE MANAGER |
| Phone | 3342636228 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 9178 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 051543495 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100662 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100663 |
| State | AL |
| Name | Role |
|---|---|
| PINKSTON, GLEN R | Agent |
| Name | Role | Address |
|---|---|---|
| JOHNSON, D KYLE | Incorporator | 150 S PERRY STMONTGOMERY, AL 36104 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
