| Name: | Fagan, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 21 Dec 1999 (25 years ago) |
| Date of dissolution: | 27 Dec 2023 |
| Entity Number: | 000-667-651 |
| Register Number: | 000667651 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 4309 CLAIRMONT AVEBIRMINGHAM, AL 35222 |
| Registered Office Street Address ZIP Code: | 35222 |
| Principal Address: | BIRMINGHAM, AL |
Activities
RENDER PROFESSIONAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770740482 | 2008-05-20 | 2011-01-06 | 3125 INDEPENDENCE DR, SUITE 300A, BIRMINGHAM, AL, 352094159, US | 3125 INDEPENDENCE DR, SUITE 300A, BIRMINGHAM, AL, 352094159, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-879-8206 |
| Fax | 2058790675 |
Authorized person
| Name | DR. KIMBERLY M FAGAN |
| Role | DOCTOR/OWNER |
| Phone | 2058798206 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 14105 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 14105 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| License Number | 14105 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE GROUP IDENTIFIER |
| Number | I621 |
| State | AL |
| Name | Role |
|---|---|
| FAGAN, KIMBERLY | Agent |
| Name | Role |
|---|---|
| FAGAN, KIMBERLY | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
