| 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
| 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 | |||||||||||||||||||||||||||||||||
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| 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 |
| Name | Role |
|---|---|
| MITCHELL, PHILLIP | Agent |
| Name | Role |
|---|---|
| MITCHELL, PHILLIP A | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
