| Name: | Comprehensive Kidney Disease Center, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 08 Dec 2010 (14 years ago) |
| Date of dissolution: | 02 May 2017 |
| Entity Number: | 000-304-925 |
| Register Number: | 000304925 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 15 MEETING STHUNTSVILLE, AL 35806 |
| Registered Office Street Address ZIP Code: | 35806 |
Activities
MEDICAL TREATMENT SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649574286 | 2010-12-22 | 2011-02-05 | 333 WHITESPORT DR SW, SUITE 205, HUNTSVILLE, AL, 358016454, US | 333 WHITESPORT DR SW, SUITE 205, HUNTSVILLE, AL, 358016454, US | |||||||||||||||||||||||
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| Phone | +1 256-489-3007 |
| Fax | 2564893045 |
Authorized person
| Name | DR. AMISH B SHAH |
| Role | MANAGER |
| Phone | 2564893007 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| License Number | 25611 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE ID TYPE UNSPECIFIED |
| Number | 051519633SHA |
| Name | Role |
|---|---|
| SHAH, AMISH | Agent |
| Name | Role |
|---|---|
| SHAH, AMISH | Member |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
