| Name: | Scottsboro OB-GYN Specialists, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 27 Sep 2001 (23 years ago) (Companies founded in September 2001) |
| Date of dissolution: | 30 Dec 2022 |
| Entity Number: | 000-677-874 |
| Register Number: | 000677874 |
| ZIP code: | 35768 (Companies in Jackson, 35768) |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Address: | SCOTTSBORO, AL |
| Registered Office Street Address: | 505 BURLINGTON STSCOTTSBORO, AL 35768 |
Activities
PROVIDE MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972658300 | 2007-01-24 | 2011-03-14 | 408 TAYLOR ST, SCOTTSBORO, AL, 357682424, US | 408 TAYLOR ST, SCOTTSBORO, AL, 357682424, US | |||||||||||||||||||||
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| Phone | +1 256-259-5211 |
| Fax | 2562596641 |
Authorized person
| Name | MELISSA CAMPBELL |
| Role | PRACTICE MANAGER |
| Phone | 2562595211 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529908600 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CAMPBELL, MELISSA | Agent | 2704 DOUBLE TREE WAYSPRING HILL, TN 37174 |
| Name | Role |
|---|---|
| PIERCE, JERRY DWAIN | Member |
| VARGAS-SANCHEZ, IVONNE | Member |
| MEGEHEE, PAUL JACOB | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
