| Name: | Urology Clinic of South Alabama, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 Aug 2007 (17 years ago) (Companies founded in August 2007) |
| Entity Number: | 000-498-474 |
| Register Number: | 000498474 |
| ZIP code: | 36420 (Companies in Covington, 36420) |
| County: | Covington |
| Place of Formation: | Covington County |
| Principal Address: | ANDALUSIA, AL |
| Registered Office Street Address: | 215 MEDICAL PARK LANE STE 2ANDALUSIA, AL 36420 |
Activities
MEDICAL PRACTICE (UROLOGY)
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013100627 | 2007-08-27 | 2008-02-14 | 215 MEDICAL PARK DR, SUITE 2, ANDALUSIA, AL, 364205311, US | 215 MEDICAL PARK DR, SUITE 2, ANDALUSIA, AL, 364205311, US | |||||||||||||||||||||||
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| Phone | +1 334-427-7218 |
| Fax | 3344274999 |
Authorized person
| Name | ALEXANDRU E BENET |
| Role | OWNER |
| Phone | 3344277218 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | AL00025839 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DG3879 |
| Name | Role |
|---|---|
| BENET, ALEXANDRU E | Member |
| Name | Role |
|---|---|
| BENET, ALEXANDRU E | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
