| Name: | Advanced Dermatology and Skin Care Specialists, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Mar 2001 (24 years ago) (Companies founded in March 2001) |
| Entity Number: | 000-674-764 |
| Register Number: | 000674764 |
| Historical Names: |
Dermatology Associates of Anniston, LLC
|
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2001 PARK PLACE STE 1400BIRMINGHAM, AL 35203-2736 |
Activities
PRACTICE OF MEDICINE/DERMATOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801969480 | 2006-11-15 | 2012-06-14 | 1419 HAMRIC DR E, SUITE 101, OXFORD, AL, 362031933, US | 1419 HAMRIC DR E, SUITE 101, OXFORD, AL, 362031933, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-235-3660 |
| Fax | 2562353663 |
Authorized person
| Name | DR. SHELLEY H RAY |
| Role | MD OWNER |
| Phone | 2562353660 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | 0023813 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529908960 |
| State | AL |
| Issuer | BC BS ALABAMA DR RAY |
| Number | 51503704 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051556655 |
| State | AL |
| Issuer | MEDICAID |
| Number | 0051503704 |
| State | AL |
| Name | Role |
|---|---|
| CORLISS, DEANE K | Agent |
| Name | Role |
|---|---|
| RAY, SHELLEY H | Member |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2007-09-26 | Name Change | Dermatology Associates of Anniston, LLC | Advanced Dermatology and Skin Care Specialists, LLC |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
