| Name: | Baldwin Internal Medicine Associates, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Mar 1998 (27 years ago) |
| Entity Number: | 000-659-426 |
| Register Number: | 000659426 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | 374 S GREENO RDFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
Activities
ANY LAWFUL BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790954345 | 2008-02-28 | 2008-06-12 | 374 S GREENO RD, FAIRHOPE, AL, 365321916, US | 374 S GREENO RD, FAIRHOPE, AL, 365321916, US | |||||||||||||||||||||||||
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| Phone | +1 251-990-5055 |
| Fax | 2519905928 |
Authorized person
| Name | MRS. JANICE J JONES |
| Role | INSURANCE CLERK |
| Phone | 2519905055 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 14135 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000029294 |
| State | AL |
| Name | Role |
|---|---|
| CHANCE, ALFRED B JR | Member |
| NICHOLSON, ERIC TODD | Member |
| Name | Role |
|---|---|
| CHANCE, ALFRED B JR | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
