| Name: | Professional Health Care Services, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 10 Jul 1996 (28 years ago) |
| Date of dissolution: | 23 Dec 2013 |
| Entity Number: | 000-654-330 |
| Register Number: | 000654330 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FOLEY, AL |
| Registered Office Street Address: | 14965 HWY 59FOLEY, AL 36535 |
| Registered Office Street Address ZIP Code: | 36535 |
Activities
MEDICAL EQUIPMENT/SUPPLIES/TRANSPORTATION SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548262850 | 2005-06-01 | 2024-05-17 | 14965 STATE HIGHWAY 59 STE 102, FOLEY, AL, 365352471, US | 14965 STATE HIGHWAY 59 STE 102, FOLEY, AL, 365352471, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 251-928-4922 |
| Fax | 2519284990 |
Authorized person
| Name | MR. TIMOTHY MIXON |
| Role | CEO |
| Phone | 2519284922 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 6714 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| License Number | 6714 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | 900048 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51596001 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000056323 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 56323 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| MIXON, TIMOTHY R | Agent | 14965 STATE HIGHWAY 59 SUITE 108FOLEY, AL 36535 |
| Name | Role | Address |
|---|---|---|
| MIXON, TIMOTHY R | Member | 14965 STATE HIGHWAY 59 SUITE 108FOLEY, AL 36535 |
| HART, JASON | Member | 4135 ATLANTA HIGHWAYMONTGOMERY, AL 36109 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
