| Name: | The Southern Alabama Surgery Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Jul 2000 (24 years ago) |
| Entity Number: | 000-670-932 |
| Register Number: | 000670932 |
| Historical Names: |
The Southern Alabama Eye Surgery Center, LLC
|
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | ---DOTHAN, AL |
| Registered Office Street Address: | 2000 INTERSTATE PARK SUITE 204MONTGOMERY, AL 36109 |
| Registered Office Street Address ZIP Code: | 36109 |
Activities
OWN/OPERATE A AMBULTORY SURGERY CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346349164 | 2006-09-21 | 2014-10-23 | 2800 ROSS CLARK CIRCLE, SUITE 3, DOTHAN, AL, 36301, US | 2800 ROSS CLARK CIR, SUITE 3, DOTHAN, AL, 363012040, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 334-793-3411 |
| Fax | 3347120227 |
Authorized person
| Name | MRS. SHARRON ALANE BYRD |
| Role | ADMINISTER |
| Phone | 3347933411 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | 12124 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 03119876A |
| State | GA |
| Issuer | MEDICAID |
| Number | 128616 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000902316A |
| State | GA |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 010306 |
| State | AL |
| Issuer | MEDICAID |
| Number | 062936700 |
| State | FL |
| Issuer | MEDICAID |
| Number | ASC0060C |
| State | AL |
| Name | Role | Address |
|---|---|---|
| THE CORPORATION COMPANY | Agent | 2000 INTERSTATE PARK DR STE 204MONTGOMERY, AL 36109 |
| Name | Role |
|---|---|
| BRUCE, RANDALL E | Member |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2000-07-26 | Name Change | The Southern Alabama Eye Surgery Center, LLC | The Southern Alabama Surgery Center, LLC |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
