| Name: | Physicians Choice Dialysis of Alabama, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 25 Apr 2003 (22 years ago) |
| Entity Number: | 000-605-311 |
| Register Number: | 000605311 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 2034 CHESTNUT STMONTGOMERY, AL 36106 |
| Principal Address ZIP Code: | 36106 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
KIDNEY DIALYSIS CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760446199 | 2006-04-13 | 2020-08-14 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 1001 FOREST AVENUE, MONTGOMERY, AL, 36106, US | |||||||||||||||||||||||||||||
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| Phone | +1 615-320-4268 |
| Fax | 8772380567 |
| Phone | +1 334-269-9416 |
| Fax | 3342690024 |
Authorized person
| Name | JOHN WINSTEL |
| Role | CHIEF ACCOUNTING OFFICER |
| Phone | 2537334501 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | S5103 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1760446199 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 60GG6 | Active | Non-Manufacturer | 2010-05-25 | 2024-02-29 | 2028-03-03 | 2024-02-29 | |||||||||||||||||||||||
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| POC | DONNA BRAWLEY |
| Phone | +1 253-382-1493 |
| Fax | +1 888-577-9570 |
| Address | 125 HOSPITAL DR, WETUMPKA, AL, 36092 1602, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | |
|---|---|
| Vendor Certified | 2023-03-03 |
| CAGE number | 45JM2 |
| Company Name | DAVITA INC. |
| CAGE Last Updated | 2024-03-29 |
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
