| Name: | Crestline Anesthesia Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 26 Jul 2013 (11 years ago) |
| Entity Number: | 000-283-398 |
| Register Number: | 000283398 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 11 ROCKDELL LANEBIRMINGHAM, AL 35213 |
| Registered Office Street Address ZIP Code: | 35213 |
| Authorized Capital: | 5,000 @ 1.00PV |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407288137 | 2013-08-05 | 2013-08-05 | PO BOX 235022, MONTGOMERY, AL, 361235022, US | 7191 CAHABA VALLEY RD, SUITE 204, BIRMINGHAM, AL, 352426402, US | |||||||||||||||||||||
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| Phone | +1 334-396-6930 |
| Fax | 3343966929 |
| Phone | +1 205-995-9967 |
Authorized person
| Name | DR. AMY ELIZABETH VAN ELKAN |
| Role | PRESIDENT |
| Phone | 3343966930 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| License Number | 00024957 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| ELKAN, AMY V | Agent |
| Name | Role | Address |
|---|---|---|
| ELKAN, AMY VAN | Director | 11 ROCKDELL LANEBIRMINGHAM, AL 35213 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
