| Name: | Gulf Coast Pain Consultants, PLLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Feb 2013 (12 years ago) (Companies founded in February 2013) |
| Entity Number: | 000-512-756 |
| Register Number: | 000512756 |
| ZIP code: | 36420 (Companies in Covington, 36420) |
| County: | Covington |
| Place of Formation: | Florida |
| Principal Mailing Address: | PO BOX 11637PENSACOLA, FL 32524 |
| Registered Office Mailing Address: | 5290 PINE RDORANGE BEACH, AL 36531 |
| Principal Address: | 135 MEDICAL PARK DR STE 2BANDALUSIA, AL 36420 |
| Registered Office Street Address: | 771 WEST MARIGOLD AVEFOLEY, AL 36535 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134788359 | 2019-06-11 | 2023-01-31 | 201 DEFENSE HWY STE 205, ANNAPOLIS, MD, 214017096, US | 855 DOWNTOWNER BLVD, MOBILE, AL, 366095403, US | |||||||||||||||||||||||||||
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| Phone | +1 855-527-7246 |
| Fax | 8338101165 |
| Phone | +1 850-484-4080 |
| Fax | 8504848801 |
Authorized person
| Name | KACEY A MONTGOMERY |
| Role | MEDICAL DIRECTOR |
| Phone | 8507916895 |
Taxonomy
| Taxonomy Code | 111NR0400X - Rehabilitation Chiropractor |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | No |
| Name | Role |
|---|---|
| LONGCRIER, CYNTHIA | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
