| Name: | Koonce Surgical, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 19 May 2015 (9 years ago) |
| Entity Number: | 000-336-529 |
| Register Number: | 000336529 |
| County: | Limestone |
| Place of Formation: | Limestone County |
| Registered Office Street Address: | 201 N MALONE STREETATHENS, AL 35611 |
| Registered Office Street Address ZIP Code: | 35611 |
| Authorized Capital: | 5000 @ $1.00 PV |
Activities
RENDER PROFESSIONAL SERVICES IN MEDICAL FIELD/SURGERY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659751915 | 2015-06-02 | 2015-06-02 | 201 N MALONE ST, ATHENS, AL, 356111509, US | 201 N MALONE ST, ATHENS, AL, 356111509, US | |||||||||||||||||||||||||
|
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| Phone | +1 256-216-6500 |
| Fax | 2562168777 |
Authorized person
| Name | DR. CASSIDY J KOONCE |
| Role | PHYSICIAN |
| Phone | 2562166500 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | MD31380 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1376854976 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| KOONCE, CASSIDY | Agent | 201 N MALONE STREETATHENS, AL 35611 |
| Name | Role | Address |
|---|---|---|
| KOONCE, CASSIDY | Director | 201 N MALONE STREETATHENS, AL 35611 |
| Name | Role | Address |
|---|---|---|
| KOONCE, CASSIDY | Incorporator | 201 N MALONE STREETATHENS, AL 35611 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
