| Name: | Physicians Choice Dialysis of Selma, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Withdrawn |
| Date of registration: | 25 Apr 2003 (22 years ago) |
| Entity Number: | 000-605-310 |
| Register Number: | 000605310 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Registered Office Street Address: | 200O INTERSTATE PARK DR STE 204MONTGOMERY, AL 36109 |
| Registered Office Street Address ZIP Code: | 36109 |
| Principal Address: | 2034 CHESTNUT STMONTGOMERY, AL 36106 |
| Principal Address ZIP Code: | 36106 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629144514 | 2006-11-24 | 2007-09-27 | PO BOX 534421, ATLANTA, GA, 303534421, US | 201 LINCOLN LN, SELMA, AL, 367017748, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 610-495-8900 |
| Fax | 6104958560 |
| Phone | +1 334-875-5436 |
| Fax | 3348728547 |
Authorized person
| Name | RHONDA PALUMBO |
| Role | ASST SECRETARY ASST TREAURER |
| Phone | 6104958900 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | S2403 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | DIA2614D |
| State | AL |
| Issuer | BLUE CROSS ALABAMA |
| Number | 012-438 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| THE CORPORATION COMPANY | Agent | 2000 INTERSTATE PARK DR STE 204MONTGOMERY, AL 36109 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
