| Name: | DCH Provider Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Jan 2018 (7 years ago) (Companies founded in January 2018) |
| Entity Number: | 000-507-196 |
| Register Number: | 000507196 |
| ZIP code: | 35401 (Companies in Tuscaloosa, 35401) |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 809 UNIVERSITY BLVD EASTTUSCALOOSA, AL 35401 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639918410 | 2024-05-22 | 2024-05-22 | 3901 GREENSBORO AVE STE A, TUSCALOOSA, AL, 354053771, US | 809 UNIVERSITY BLVD E, TUSCALOOSA, AL, 354012029, US | |||||||||||||||||||||
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| Phone | +1 205-759-6165 |
Authorized person
| Name | MR. DANIEL CLAY CONVILLE |
| Role | CORP DIRECTOR, PHYSICIAN SERVICES |
| Phone | 2057596165 |
Taxonomy
| Taxonomy Code | 2085B0100X - Body Imaging Physician |
| Is Primary | No |
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2085R0204X - Vascular & Interventional Radiology Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| JONES, CHRIS | Agent | 4204 SCHOOL STREETADAMSVILLE, AL 35005 |
| Name | Role | Address |
|---|---|---|
| SNOW, STEPHEN E | Organizer | 1201 GREENSBORO AVETUSCALOOSA, AL 35401 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
