| Name: | Psychiatry 280 P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 19 Dec 2014 (10 years ago) |
| Entity Number: | 000-324-720 |
| Register Number: | 000324720 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 5479 HIGHWAY 280 STE 114BIRMINGHAM, AL 35242 |
| Registered Office Street Address ZIP Code: | 35242 |
| Authorized Capital: | 1,000 @ $1.00PV |
Activities
MEDICINE/PSYCHIATRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528456779 | 2014-12-22 | 2023-10-02 | 3840 REDDICK RD, PALMYRA, TN, 371422141, US | 2803 GREYSTONE COMMERCIAL BLVD STE 12, BIRMINGHAM, AL, 352429603, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-499-1629 |
| Fax | 4235230994 |
| Phone | +1 205-968-1227 |
| Fax | 2059681229 |
Authorized person
| Name | DR. SAMUEL ANDREW POLEK |
| Role | OWNER |
| Phone | 2564991629 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | MD32834 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 171037 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| POLEK, SAMUEL A | Director | 6301 OLD MILL CIRCLELEEDS, AL 35094 |
| Name | Role | Address |
|---|---|---|
| POLEK, SAMUEL A | Incorporator | 6301 OLD MILL CIRCLELEEDS, AL 35094 |
| Name | Role | Address |
|---|---|---|
| POLEK, SAMUEL A | Agent | 6301 OLD MILL CIRCLELEEDS, AL 35094 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
