Name: | Cutaneous Oncology & Surgery Center, LLC |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Exists |
Date of registration: | 27 Sep 2011 (13 years ago) |
Entity Number: | 000-026-194 |
Register Number: | 000026194 |
ZIP code: | 35242 |
County: | Shelby |
Place of Formation: | Jefferson County |
Registered Office Street Address: | 2000 STONEGATE TRAIL SUITE 12BIRMINGHAM, AL 35242 |
Activities
SURGERY CENTER
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1699139915 | 2016-04-12 | 2020-03-04 | 1940 STONEGATE DR STE 140, VESTAVIA HLS, AL, 352422541, US | 1940 STONEGATE DR STE 140, VESTAVIA HLS, AL, 352422541, US | |||||||||||||||||||||||||||||||||||
|
Phone | +1 205-968-3919 |
Fax | 2059683918 |
Authorized person
Name | DR. CHRISTOPHER HARMON |
Role | OWNER |
Phone | 2059779876 |
Taxonomy
Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
State | AL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
Number | 014-348 |
State | AL |
Issuer | CMS CCN |
Number | 01C0001056 |
State | AL |
Issuer | STATE LICENSE |
Number | U3714 |
State | AL |
Name | Role | Address |
---|---|---|
HARMON, CHRISTOPHER B | Agent | 33 INVERNESS CENTER PARKWAYBIRMINGHAM, AL 35242 |
Name | Role | Address |
---|---|---|
HARMON, CHRISTOPHER B | Organizer | 33 INVERNESS CENTER PARKWAYBIRMINGHAM, AL 35242 |
LEVY, JACK B | Organizer | 1819 FIFTH AVENUE NBIRMINGHAM, AL 35203 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State