| Name: | Cardiothoracic Surgical Associates of Montgomery LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 19 Mar 2004 (21 years ago) |
| Date of dissolution: | 04 Mar 2013 |
| Entity Number: | 000-698-614 |
| Register Number: | 000698614 |
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104 |
Activities
PROVIDE CARDIAC/THORACIC/VASCULAR SURGICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639112964 | 2006-06-14 | 2009-06-23 | 2055 E SOUTH BLVD, SUITE 708, MONTGOMERY, AL, 361162001, US | 2055 E SOUTH BLVD, SUITE 708, MONTGOMERY, AL, 361162001, US | |||||||||||||||||||||||||
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| Phone | +1 334-288-1033 |
| Fax | 3342888823 |
Authorized person
| Name | JAMES W BLATCHFORD III |
| Role | OWNER |
| Phone | 3342881033 |
Taxonomy
| Taxonomy Code | 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
| License Number | 0006734 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529920080 |
| State | AL |
| Name | Role |
|---|---|
| BLATCHFORD, JAMES III | Member |
| CIEUTAT, EVE | Member |
| Name | Role | Address |
|---|---|---|
| BUSINESS FILINGS INCORPORATED | Agent | 8020 EXCELSIOR DRIVE STE 200MADISON, WI 53717 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
