| Name: | DeKalb Emergency Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 15 Dec 2009 (15 years ago) |
| Date of dissolution: | 23 Jan 2024 |
| Entity Number: | 000-441-210 |
| Register Number: | 000441210 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790015923 | 2010-01-11 | 2016-01-11 | 200 CORPORATE BLVD, LAFAYETTE, LA, 705083870, US | 200 MEDICAL CENTER DR SW, FORT PAYNE, AL, 359683458, US | |||||||||||||||||||||||||||||
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| Phone | +1 337-354-1153 |
| Phone | +1 256-845-3150 |
Authorized person
| Name | LISHA FALK |
| Role | VP OF CONTRACTING |
| Phone | 8008939698 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 363AM0700X - Medical Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 116633 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role |
|---|---|
| SCHUMACHER MEDICAL CORPORATION OF | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
