| Name: | Physicians Choice Dialysis of Alexander City, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Withdrawn |
| Date of registration: | 03 Jun 2004 (20 years ago) |
| Entity Number: | 000-606-961 |
| Register Number: | 000606961 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 2034 CHESTNUT STMONTGOMERY, AL 36106 |
| Principal Address ZIP Code: | 36106 |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
DIALYSIS CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861425621 | 2006-07-07 | 2007-09-27 | 211 COMMERCE CT, SUITE 104, POTTSTOWN, PA, 194643483, US | 3316 HIGHWAY 280 BYPASS, SUITE G1, ALEXANDER CITY, AL, 350103369, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 610-495-8900 |
| Fax | 6104958560 |
| Phone | +1 256-329-0638 |
| Fax | 2563298934 |
Authorized person
| Name | MRS. RHONDA B. PALUMBO |
| Role | DIRECTOR OF CONTRACTS/HR |
| Phone | 6104958900 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | 12110 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS ALABAMA |
| Number | 012-502 |
| State | AL |
| Issuer | MEDICAID |
| Number | DIA2617D |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
