| Name: | Mountain Brook Plastic Surgery & Laser Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 26 Apr 2002 (23 years ago) |
| Date of dissolution: | 27 May 2015 |
| Entity Number: | 000-681-880 |
| Register Number: | 000681880 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | MOUNTAIN BROOK, AL |
| Registered Office Street Address: | 2850 CAHABA RD STE 100MOUNTAIN BROOK, AL 35223 |
| Registered Office Street Address ZIP Code: | 35223 |
Activities
PRACTICE MEDICINE/PLASTIC SURGERY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093939894 | 2007-04-12 | 2020-08-22 | 2850 CAHABA RD, SUITE 100, BIRMINGHAM, AL, 352232346, US | 2850 CAHABA RD, SUITE 100, BIRMINGHAM, AL, 352232346, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 205-871-4440 |
| Fax | 2058717776 |
Authorized person
| Name | MRS. LAUREN RIVES |
| Role | CLINICAL MANAGER |
| Phone | 2058714440 |
Taxonomy
| Taxonomy Code | 2086S0122X - Plastic and Reconstructive Surgery Physician |
| License Number | AL16730 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTH CARE |
| Number | 1310014 |
| State | AL |
| Name | Role |
|---|---|
| COLLAWN, SHERRY | Agent |
| Name | Role |
|---|---|
| COLLAWN, SHERRY | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
