| Name: | Patrick Ifediba MD LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 25 Sep 2007 (17 years ago) |
| Entity Number: | 000-410-701 |
| Register Number: | 000410701 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 1300 BESSEMER RDBIRMINGHAM, AL 35208 |
| Registered Office Street Address ZIP Code: | 35208 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902085582 | 2007-10-30 | 2010-07-19 | PO BOX 59472, BIRMINGHAM, AL, 352599472, US | 1300 BESSEMER RD, BIRMINGHAM, AL, 352084326, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-929-0565 |
| Fax | 2059290564 |
Authorized person
| Name | PATRICK EMEKA IFEDIBA |
| Role | DIRECTOR |
| Phone | 2059290565 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 19014 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 51000499 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051554814 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| IFEDIBA, PATRICK | Agent | 1300 BESSEMER ROADBIRMINGHAM, AL 35208 |
| Name | Role | Address |
|---|---|---|
| IFEDIBA, PATRICK | Member | 1300 BESSEMER ROADBIRMINGHAM, AL 35208 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
