| Name: | Over The Mountain Internal Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 02 Sep 2009 (15 years ago) |
| Date of dissolution: | 09 Sep 2013 |
| Entity Number: | 000-437-876 |
| Register Number: | 000437876 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2636 DOLLY RIDGE RDBIRMINGHAM, AL 35243 |
| Registered Office Street Address ZIP Code: | 35243 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104059344 | 2009-09-03 | 2009-12-11 | 2018 BROOKWOOD MEDICAL CTR DR, STE 315, BIRMINGHAM, AL, 352096898, US | 2018 BROOKWOOD MEDICAL CTR DR, STE 315, BIRMINGHAM, AL, 352096898, US | |||||||||||||||||||
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| Phone | +1 205-877-5400 |
| Fax | 2058775040 |
Authorized person
| Name | DR. VICKI R MARTIN |
| Role | OWNER/PHYSICIAN |
| Phone | 2058775400 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 14251 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| MARTIN, VICKI RUTLAND | Agent |
| Name | Role |
|---|---|
| MARTIN, VICKI RUTLAND | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
