| Name: | Open MRI of Shelby, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 07 Jun 2001 (23 years ago) |
| Date of dissolution: | 30 Nov 2023 |
| Entity Number: | 000-676-131 |
| Register Number: | 000676131 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 924 MONTCLAIR RD STE 108BIRMINGHAM, AL 35213 |
| Registered Office Street Address ZIP Code: | 35213 |
Activities
OWN/LEASE PHYSICIAN OFFICE SPACE/MEDICAL EQUIPMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1649241639 | 2006-01-30 | 2020-10-28 | PO BOX 932545, ATLANTA, GA, 311932545, US | 224 1ST ST N, SUITE 150, ALABASTER, AL, 350078742, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-995-9899 |
| Fax | 2059951255 |
| Phone | +1 205-663-4674 |
| Fax | 2056634807 |
Authorized person
| Name | TRACI BROWN |
| Role | DIRECTOR OF BILLING |
| Phone | 7062563450 |
Taxonomy
| Taxonomy Code | 261QR0200X - Radiology Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | JAMES SPANN, M.D NPI # |
| Number | 1306051164 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529909650 |
| State | AL |
| Issuer | CECIL EILAND, MD |
| Number | 1235111451 |
| State | AL |
| Issuer | UHC - PROVIDER ID |
| Number | 1600471 |
| State | AL |
| Issuer | JAMES SPANN, M.D. - BCBS ID # |
| Number | 51116991 |
| State | AL |
| Issuer | BCBS - FACILITY ID # |
| Number | 51551244 |
| State | AL |
| Issuer | ROBERT EICHELBERGER, MD |
| Number | 1427030642 |
| State | AL |
| Issuer | N. MELINDA BERGQUIST, MD |
| Number | 1023040409 |
| State | AL |
| Issuer | RUTH SNOW, MD |
| Number | 1124000344 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| EICHELBERGER, ROBERT P | Agent | 7500 DANIEL DRBIRMINGHAM, AL 35242 |
| Name | Role | Address |
|---|---|---|
| EICHELBERGER, ROBERT P | Member | 7500 DANIEL DRBIRMINGHAM, AL 35242 |
| CYPRESS PARTNERS LLC | Member | No data |
| REICH, CAROLINE A | Member | No data |
| BURKE, SAMUEL J | Member | No data |
| GODDARD, MARK | Member | No data |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
