| Name: | Brookwood Primary Care Cahaba Heights, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 11 Jul 2007 (17 years ago) |
| Date of dissolution: | 01 Jul 2022 |
| Entity Number: | 000-497-038 |
| Register Number: | 000497038 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790975217 | 2007-07-31 | 2016-05-26 | 4902 VALLEYDALE RD, BIRMINGHAM, AL, 352424613, US | 4274 CAHABA HEIGHTS CT, SUITE 130, BIRMINGHAM, AL, 352435712, US | |||||||||||||||||||||||||||
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| Phone | +1 205-980-8099 |
| Fax | 2059802606 |
| Phone | +1 205-977-8484 |
Authorized person
| Name | MR. WESLEY O. JAMES |
| Role | REGIONAL CFO, TENET |
| Phone | 4042655009 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 20180 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529932928 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role | Address |
|---|---|---|
| BROOKWOOD PRIMARY NETWORK CARE INC | Member | 1445 ROSS AVENUE SUITE 1400DALLAS, TX 75202 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
