| Name: | Madison Primary Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 Feb 2011 (14 years ago) |
| Entity Number: | 000-003-877 |
| Register Number: | 000003877 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 3776 SULLIVAN STREET SUITE DMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
Activities
LICENSED PHYSICIAN RENDERING SEVICES TO THE PUBLIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881993210 | 2011-03-24 | 2023-08-01 | 400 SUN TEMPLE DR, MADISON, AL, 357585924, US | 400 SUN TEMPLE DR, MADISON, AL, 357585924, US | |||||||||||||||||||||
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| Phone | +1 256-774-5524 |
| Fax | 2567745523 |
Authorized person
| Name | MR. ADEEL BODLA |
| Role | PHYSICIAN |
| Phone | 6266447722 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BODLA, ADEEL A | Organizer | 3776 SULLIVAN STREET SUITE DMADISON, AL 35758 |
| Name | Role | Address |
|---|---|---|
| BODLA, ADEEL A | Agent | 3776 SULLIVAN STREET SUITE DMADISON, AL 35758 |
Date of last update: 29 Jul 2024
Sources: Alabama Secretary of State
