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Physicians Choice Dialysis of Selma, LLC

Details

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Status: Withdrawn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) (Companies founded in April 2003)
Entity Number: 000-605-310
Register Number: 000605310
ZIP code: 36106 (Companies in Montgomery, 36106)
County: Montgomery
Place of Formation: Delaware
Registered Office Street Address: 200O INTERSTATE PARK DR STE 204MONTGOMERY, AL 36109
Principal Address: 2034 CHESTNUT STMONTGOMERY, AL 36106

National Provider Identifier

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

Contacts

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

Agent

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