| Name: | Etowah Ear Nose & Throat, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 Mar 2014 (11 years ago) (Companies founded in March 2014) |
| Entity Number: | 000-298-889 |
| Register Number: | 000298889 |
| ZIP code: | 35903 (Companies in Etowah, 35903) |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Principal Address: | 1026 GOODYEAR AVENUE SUITE 100BGADSDEN, AL 35903 |
Activities
ANY LAWFUL BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881017424 | 2014-02-03 | 2014-02-03 | PO BOX 8365, GADSDEN, AL, 359028365, US | 1026 GOODYEAR AVE - STE. 100B, GADSDEN, AL, 359031194, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 256-543-2867 |
| Fax | 2564594791 |
| Phone | +1 256-438-5821 |
| Fax | 2564674262 |
Authorized person
| Name | ROBERT E. OSTERDORF III |
| Role | PHYSICIAN |
| Phone | 2564385821 |
Taxonomy
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| License Number | MD27282 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009912008 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| OSTENDORF, ROBERT E III | Agent | 1026 GOODYEAR AVENUE SUITE 100BGADSDEN, AL 35903 |
| Name | Role | Address |
|---|---|---|
| OSTENDORF, ROBERT E III | Organizer | 1026 GOODYEAR AVENUE SUITE 100BGADSDEN, AL 35903 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
