| Name: | Alabama Digestive Health Endoscopy Center L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 Jun 2004 (20 years ago) |
| Entity Number: | 000-452-358 |
| Register Number: | 000452358 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
ENDOSCOPY/AMBULATORY SURGERY CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538758297 | 2021-01-15 | 2021-01-15 | 2018 BROOKWOOD MEDICAL CTR DR, BIRMINGHAM, AL, 352096898, US | 2018 BROOKWOOD MEDICAL CTR DR, BIRMINGHAM, AL, 352096898, US | |||||||||||||||||||
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| Phone | +1 205-877-1187 |
Authorized person
| Name | TARA SHEA |
| Role | ADMINISTRATOR |
| Phone | 2058771114 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 011072 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ADHEC 401(K) PLAN | 2009 | 201243484 | 2010-09-16 | ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER | 13 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 201243484 |
| Plan administrator’s name | ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER |
| Plan administrator’s address | 2010 BROOKWOOD MEDICAL CENTER DR, BIRMINGHAM, AL, 35209 |
| Administrator’s telephone number | 2058246250 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-16 |
| Name of individual signing | MIKE RICKMAN |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 6190 POWERS FERRY RD STE 600ATLANTA, GA 30339 |
| Name | Role | Address |
|---|---|---|
| DICKINSON, DOUGLAS S | Member | 2020 LAKE HEATHER DRIVEBIRMINGHAM, AL 35242 |
| LANDY, DAVID | Member | No data |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
