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Bradberry Medical, LLC

Details

Name: Bradberry Medical, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Dissolved
Date of registration: 30 Jan 2004 (21 years ago) (Companies founded in January 2004)
Date of dissolution: 24 Jun 2016
Entity Number: 000-696-939
Register Number: 000696939
ZIP code: 36695 (Companies in Mobile, 36695)
County: Mobile
Place of Formation: Mobile County
Principal Address: MOBILE, AL
Registered Office Street Address: 7856 WESTSIDE PARK DR STE CMOBILE, AL 36695

Activities SELL/RENT MEDICAL EQUIPMENT/SUPPLIES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1992763486 2006-05-03 2010-05-06 7856 WESTSIDE PARK DR, SUITE C, MOBILE, AL, 366958541, US 839 AIRPORT DRIVE, SUITE 102, ALEXANDER CITY, AL, 35010, US

Contacts

Phone +1 251-633-8090
Fax 2516336941
Phone +1 256-215-8654
Fax 2562158655

Authorized person

Name JERRY CARL JR.
Role CEO/PRESIDENT
Phone 2516338090

Taxonomy

Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 009932861
State AL
Issuer BLUE CROSS BLUE SHIELD
Number 51526590
State AL

Member

Name Role
CARL, JERRY LEE JR Member

Agent

Name Role
CARL, JERRY LEE JR Agent

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State