| Name: | Indian Hills Plastic Surgery, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 May 2022 (3 years ago) |
| Entity Number: | 001-017-537 |
| Register Number: | 001017537 |
| County: | Tuscaloosa |
| Place of Formation: | Alabama |
| Principal Address: | 3601 Watermelon Rd.Tuscaloosa, AL 35406 |
| Principal Address ZIP Code: | 35406 |
| Authorized Capital: | 5000 |
| Paid Share Capital: | 1.00 |
Activities
Medical practice
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104555770 | 2022-06-08 | 2022-06-08 | 3901 GREENSBORO AVE STE A, TUSCALOOSA, AL, 354053771, US | 3601 WATERMELON RD, NORTHPORT, AL, 354735138, US | |||||||||||||||
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| Phone | +1 205-759-6165 |
| Phone | +1 205-333-4661 |
Authorized person
| Name | DANIEL CLAY CONVILLE |
| Role | DIRECTOR, PHYSICIAN SERVICES |
| Phone | 2057596165 |
Taxonomy
| Taxonomy Code | 208200000X - Plastic Surgery Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Wallace, Chelsea | Agent |
| Name | Role | Address |
|---|---|---|
| Poellnitz, Farley A | Incorporator | 1201 Greensboro Ave.Tuscaloosa, AL 35401 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
