| Name: | Evernorth Care Providers - Tennessee PC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Jun 2023 (2 years ago) |
| Entity Number: | 001-097-276 |
| Register Number: | 001097276 |
| ZIP code: | 35244 |
| County: | Jefferson |
| Place of Formation: | Tennessee |
| Principal Mailing Address: | 730 COOL SPRINGS BLVD SUITE 500FRANKLIN, TN 37067 |
| Registered Office Street Address: | 2 NORTH JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Principal Address: | 2 CHASE CORPORATE DR. #300BIRMINGHAM, AL 35244 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356128904 | 2023-09-08 | 2024-02-14 | 730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN, 370677331, US | 2700 CORPORATE DR STE 200, BIRMINGHAM, AL, 352422733, US | |||||||||||||||
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| Phone | +1 773-292-4800 |
| Fax | 3125644059 |
Authorized person
| Name | GRACE V BLUE |
| Role | CREDENTIALING SR. MANAGER |
| Phone | 7732924800 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
Date of last update: 18 Aug 2024
Sources: Alabama Secretary of State
