| Name: | Pediatric Partners of Mobile, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Jul 2003 (21 years ago) |
| Entity Number: | 000-691-728 |
| Register Number: | 000691728 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 1605 UNIVERSITY BLVD SMOBILE, AL 36609 |
| Registered Office Street Address ZIP Code: | 36609 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134286131 | 2007-01-02 | 2020-08-22 | 1605 UNIVERSITY BLVD S, MOBILE, AL, 366092960, US | 1605 UNIVERSITY BLVD S, MOBILE, AL, 366092960, US | |||||||||||||||||||||||
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| Phone | +1 251-660-9393 |
| Fax | 2516620372 |
Authorized person
| Name | DWIGHT A YODER |
| Role | OWNER |
| Phone | 2516609393 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 06603872 |
| State | MS |
| Name | Role |
|---|---|
| YODER, DWIGHT A | Agent |
| Name | Role |
|---|---|
| YODER, DWIGHT A | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
