| Name: | Olive Tree Healthcare, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 17 Jan 2008 (17 years ago) |
| Date of dissolution: | 28 Dec 2018 |
| Entity Number: | 000-255-761 |
| Register Number: | 000255761 |
| County: | Covington |
| Place of Formation: | Covington County |
| Principal Address: | ANDALUSIA, AL |
| Registered Office Street Address: | 301 MEDICAL AVE STE BANDALUSIA, AL 36420 |
| Registered Office Street Address ZIP Code: | 36420 |
| Authorized Capital: | $2,000 |
Activities
MEDICAL PRACTICE
| 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 | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| 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 |
| Name | Role |
|---|---|
| BIRK, RAINER A | Agent |
| Name | Role |
|---|---|
| BIRK, RAINER A | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
