| Name: | Eastern Shore Children's Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 28 Jun 1984 (41 years ago) |
| Entity Number: | 000-098-793 |
| Register Number: | 000098793 |
| ZIP code: | 36532 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 150 S INGLESIDE STREET SUITE 7FAIRHOPE, AL 36532 |
| Authorized Capital: | $10,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447614854 | 2016-04-12 | 2022-04-19 | PO BOX 989, FAIRHOPE, AL, 365330989, US | 9603 STAGECOACH COMMERCIAL PARK CIRCLE, SPANISH FORT, AL, 36527, US | |||||||||||||||||||
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| Phone | +1 251-928-0624 |
Authorized person
| Name | HENRY ELLIOT LEE |
| Role | OFFICE MANAGER |
| Phone | 2519280624 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4018429 |
| State | AL |
| Name | Role |
|---|---|
| MOORE, MARGARET T | Agent |
| Name | Role |
|---|---|
| WALKER, ALBERT BEDFORD JR | Incorporator |
| WIGGINS, WARNER MERRILL | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
