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Professional Health Care Services, L.L.C.

Details

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) (Companies founded in July 1996)
Date of dissolution: 23 Dec 2013
Entity Number: 000-654-330
Register Number: 000654330
ZIP code: 36535 (Companies in Baldwin, 36535)
County: Baldwin
Place of Formation: Baldwin County
Principal Address: FOLEY, AL
Registered Office Street Address: 14965 HWY 59FOLEY, AL 36535

Activities MEDICAL EQUIPMENT/SUPPLIES/TRANSPORTATION SERVICES

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
MIXON, TIMOTHY R Agent 14965 STATE HIGHWAY 59 SUITE 108FOLEY, AL 36535

Member

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