| Name: | MiBella Gynecology, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Aug 2010 (14 years ago) |
| Entity Number: | 000-300-554 |
| Register Number: | 000300554 |
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Principal Address: | 2807 GREYSTONE COMMERCIAL BLVD, UNIT 38BIRMINGHAM, AL 35242 |
| Principal Address ZIP Code: | 35242 |
Activities
PRIVATE PRACTICE OF GYNECOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720393606 | 2010-08-16 | 2021-09-29 | 2807 GREYSTONE COMMERCIAL BLVD, UNIT 38, BIRMINGHAM, AL, 352429601, US | 2807 GREYSTONE COMMERCIAL BLVD, UNIT 38, BIRMINGHAM, AL, 352429601, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-995-1009 |
| Fax | 2059951049 |
Authorized person
| Name | MIA T COWAN |
| Role | PRESIDENT |
| Phone | 2059951009 |
Taxonomy
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| License Number | 27416 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | 27416 |
| State | AL |
| Issuer | MEDICAID |
| Number | 1831127083 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MIBELLA WELLNESS CENTER 401(K) PLAN | 2023 | 273234298 | 2024-10-02 | MIBELLA GYNECOLOGY, LLC | 12 | |||||||||||||
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| MIBELLA WELLNESS CENTER 401(K) PLAN | 2022 | 273234298 | 2023-10-12 | MIBELLA GYNECOLOGY, LLC | 13 | |||||||||||||
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| MIBELLA WELLNESS CENTER 401(K) PLAN | 2021 | 273234298 | 2022-10-11 | MIBELLA GYNECOLOGY, LLC | 10 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| COWAN, MIA | Agent | 2807 GREYSTONE COMMERCIAL BLVD, UNIT 38BIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| COWAN, MIA | Member | 2807 GREYSTONE COMMERCIAL BLVD, UNIT 38BIRMINGHAM, AL 35242 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
