| Name: | Elena Herndon, M.D., L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 20 May 2003 (22 years ago) |
| Date of dissolution: | 04 Jan 2018 |
| Entity Number: | 000-690-367 |
| Register Number: | 000690367 |
| ZIP code: | 35209 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 2018 BROOKWOOD MEDICAL CENTER DR STE 310HOMEWOOD, AL 35209 |
Activities
PROVIDE PSYCHIATRIC SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760605315 | 2007-04-11 | 2020-08-22 | 2018 BROOKWOOD MEDICAL CTR DR, POB SUITE 311, BIRMINGHAM, AL, 352096898, US | 2018 BROOKWOOD MEDICAL CTR DR, POB SUITE 311, BIRMINGHAM, AL, 352096898, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 205-329-7805 |
Authorized person
| Name | DR. ELENA HERNDON |
| Role | OWNER |
| Phone | 2053297805 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | 25308 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | P00078330 |
| State | AL |
| Name | Role |
|---|---|
| HERNDON, ELENA | Member |
| Name | Role |
|---|---|
| HERNDON, ELENA | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
