| Name: | Southside Medical Service, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 16 Oct 2020 (4 years ago) |
| Entity Number: | 000-785-488 |
| Register Number: | 000785488 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 3413 MOSS BROOK LANEVESTAVIA HILLS, AL 35243 |
| Registered Office Street Address ZIP Code: | 35243 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639767742 | 2021-01-05 | 2021-01-05 | 3413 MOSS BROOK LN, VESTAVIA, AL, 352434951, US | 510 WOLF CREEK RD N, PELL CITY, AL, 351252477, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 205-753-3462 |
Authorized person
| Name | STEPHEN FORTSON |
| Role | OWNER/MD |
| Phone | 2057533462 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| FORTSON, STEPHEN | Agent | 3413 MOSS BROOK LANEVESTAVIA HILLS, AL 35243 |
| Name | Role | Address |
|---|---|---|
| FORTSON, STEPHEN | Organizer | 3413 MOSS BROOK LANEVESTAVIA HILLS, AL 35243 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
