| Name: | Eastern Shore Health Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Feb 2007 (18 years ago) |
| Entity Number: | 000-490-423 |
| Register Number: | 000490423 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | #304 82 PLANTATION PLACEFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
Activities
MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447459748 | 2007-07-16 | 2021-01-07 | 908 PLANTATION BLVD, FAIRHOPE, AL, 365322952, US | 908 PLANTATION BLVD, FAIRHOPE, AL, 365322952, US | |||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 251-990-2292 |
| Fax | 2519902293 |
Authorized person
| Name | DR. SUZANNE TORMOEN |
| Role | MANAGER |
| Phone | 2519902292 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 510-95646 |
| State | AL |
| Issuer | UNITED HEALTH CARE |
| Number | 11454869 |
| State | AL |
| Issuer | AHCCS |
| Number | 1266173 |
| Issuer | MEDICAID |
| Number | 000095646 |
| State | AL |
| Issuer | NPI FOR DR. SUZANNETORMOE |
| Number | 1356309496 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| TORMOEN, SUZANNE | Agent | 713 HOLLY DRIVEFAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| TORMOEN, SUZANNE | Member | 713 HOLLY DRIVEFAIRHOPE, AL 36532 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
