| Name: | Obelisk Healthcare, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 Jul 2003 (21 years ago) |
| Entity Number: | 000-691-405 |
| Register Number: | 000691405 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | 4705 WOODMERE BLVDMONTGOMERY, AL 36106 |
| Principal Address ZIP Code: | 36106 |
| Registered Office Street Address: | 9273 HANSTON PLMONTGOMERY, AL 36117 |
| Registered Office Street Address ZIP Code: | 36117 |
Activities
MEDICAL PRACTICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841472529 | 2007-12-04 | 2009-10-15 | 4705 WOODMERE BLVD, MONTGOMERY, AL, 361063078, US | 4705 WOODMERE BLVD, MONTGOMERY, AL, 361063078, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-558-0262 |
| Fax | 3345580267 |
Authorized person
| Name | DIONNE WILLIAMS |
| Role | OFFICE MANAGER |
| Phone | 3345580262 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | 20243 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS ALABAMA |
| Number | 515-21545 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529922860 |
| State | AL |
| Name | Role |
|---|---|
| BEAUCHAMP, D'LIVRO | Agent |
| Name | Role |
|---|---|
| BEAUCHAMP, D'LIVRO | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
