| Name: | Emerald Sands Medical Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Limited Liability Company |
| Status: | Exists |
| Date of registration: | 28 Jun 2019 (5 years ago) (Companies founded in June 2019) |
| Entity Number: | 000-580-371 |
| Register Number: | 000580371 |
| ZIP code: | 36535 (Companies in Baldwin, 36535) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 8158 STATE HIGHWAY 59 STE 107FOLEY, AL 36535 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699180315 | 2014-06-23 | 2014-06-23 | 8158 US HWY 59, SUITE 107, FOLEY, AL, 36535, US | 8158 US HWY 59, SUITE 107, FOLEY, AL, 36535, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-955-1600 |
Authorized person
| Name | CHARLES BUCKMASTER |
| Role | M.D. |
| Phone | 2519551600 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 20768 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 1-131772 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106106 |
| State | AL |
| Name | Role |
|---|---|
| BUCKMASTER, CHARLES | Agent |
| Name | Role | Address |
|---|---|---|
| OLMSTEAD, CRAIG D | Organizer | 234 OFFICE PARK DRIVEGULF SHORES, AL 36542 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
