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Mitchell Oral Surgery, LLC

Details

Name: Mitchell Oral Surgery, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 29 Jan 2002 (23 years ago)
Entity Number: 000-680-260
Register Number: 000680260
County: Shelby
Place of Formation: Shelby County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 5511 HIGHWAY 280 SOUTH STE 118BIRMINGHAM, AL 35242
Registered Office Street Address ZIP Code: 35242

Activities MEDICAL/DENTAL PRACTICE OF ORAL SURGERY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1427146489 2006-10-11 2020-08-22 5511 HIGHWAY 280, SUITE 118, BIRMINGHAM, AL, 352426585, US 5511 HIGHWAY 280, SUITE 118, BIRMINGHAM, AL, 352426585, US

Contacts

Phone +1 205-980-9000
Fax 2059801399

Authorized person

Name DR. PHILLIP ANTHONY MITCHELL
Role OWNER
Phone 2059809000

Taxonomy

Taxonomy Code 1223S0112X - Oral and Maxillofacial Surgery (Dentist)
License Number 03787
State AL
Is Primary No
Taxonomy Code 204E00000X - Oral & Maxillofacial Surgery (D.M.D.)
License Number 17041
State AL
Is Primary No

Other Provider Identifiers

Issuer BCBS
Number 06576
State AL

Agent

Name Role
MITCHELL, PHILLIP Agent

Member

Name Role
MITCHELL, PHILLIP A Member

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State