| Name: | Bradberry Medical, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 30 Jan 2004 (21 years ago) |
| Date of dissolution: | 24 Jun 2016 |
| Entity Number: | 000-696-939 |
| Register Number: | 000696939 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 7856 WESTSIDE PARK DR STE CMOBILE, AL 36695 |
| Registered Office Street Address ZIP Code: | 36695 |
Activities
SELL/RENT MEDICAL EQUIPMENT/SUPPLIES
| 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 | |||||||||||||||||||||||||||||||
|
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| 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 |
| Name | Role |
|---|---|
| CARL, JERRY LEE JR | Member |
| Name | Role |
|---|---|
| CARL, JERRY LEE JR | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
