| Name: | Eastern Shore Cosmetic Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 11 Mar 2014 (11 years ago) |
| Entity Number: | 000-299-239 |
| Register Number: | 000299239 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 7541 CIPRIANO COURTFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | 100000 @ $.01PV |
Activities
PRACTICE OF MEDICINE/COSMETIC SURGERY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831592930 | 2014-10-02 | 2014-10-02 | 7541 CIPRIANO CT, FAIRHOPE, AL, 365323029, US | 7541 CIPRIANO CT, FAIRHOPE, AL, 365323029, US | |||||||||||||||||||
|
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| Phone | +1 251-929-7850 |
| Fax | 2519292500 |
Authorized person
| Name | MRS. DENVIA POTTER |
| Role | SURGICAL COORDINATOR |
| Phone | 2519297850 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| License Number | 23669 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KOEHLER, JAMES | Agent | 7541 CIPRIANO COURTFAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| LYLE, JOHN F III | Incorporator | PO BOX 2329FAIRHOPE, AL 36533 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
