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Olive Tree Healthcare, P.C.

Details

Name: Olive Tree Healthcare, P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Dissolved
Date of registration: 17 Jan 2008 (17 years ago) (Companies founded in January 2008)
Date of dissolution: 28 Dec 2018
Entity Number: 000-255-761
Register Number: 000255761
ZIP code: 36420 (Companies in Covington, 36420)
County: Covington
Place of Formation: Covington County
Principal Address: ANDALUSIA, AL
Registered Office Street Address: 301 MEDICAL AVE STE BANDALUSIA, AL 36420
Authorized Capital: $2,000

Activities MEDICAL PRACTICE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1538337035 2008-02-19 2008-02-19 301 MEDICAL AVENUE, SUITE B, ANDALUSIA, AL, 36420, US 301 MEDICAL AVENUE, SUITE B, ANDALUSIA, AL, 36420, US

Contacts

Phone +1 334-222-8734
Fax 3342228736

Authorized person

Name RAINER ALEJANDRO BIRK
Role MD/PRESIDENT
Phone 3342228734

Taxonomy

Taxonomy Code 207R00000X - Internal Medicine Physician
License Number 28503
State AL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number PENDING
State AL

Agent

Name Role
BIRK, RAINER A Agent

Incorporator

Name Role
BIRK, RAINER A Incorporator

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State