| Name: | South Baldwin Pediatrics, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Aug 2003 (21 years ago) (Companies founded in August 2003) |
| Entity Number: | 000-692-333 |
| Register Number: | 000692333 |
| ZIP code: | 36535 (Companies in Baldwin, 36535) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FOLEY, AL |
| Registered Office Street Address: | 1628 N MCKENZIE STFOLEY, AL 36535 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851515878 | 2007-04-12 | 2008-04-20 | 1090 EAST LAUREL AVENUE, FOLEY, AL, 365352248, US | 1090 EAST LAUREL AVENUE, FOLEY, AL, 365352248, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 251-943-7901 |
| Fax | 2519431949 |
Authorized person
| Name | DR. GARY ALLEN EBERLY |
| Role | PHYSICIAN |
| Phone | 2519437901 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 21260 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 18394 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 1-050138 |
| State | AL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| EBERLY, GARY A | Agent | 14895 BLUFF ROADSUMMERDALE, AL 36580 |
| Name | Role | Address |
|---|---|---|
| EBERLY, GARY A | Member | 14895 BLUFF ROADSUMMERDALE, AL 36580 |
| SANFORD, DAVID W | Member | No data |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
