| Name: | Phenix City Pain Management, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 Mar 2011 (14 years ago) |
| Entity Number: | 000-006-961 |
| Register Number: | 000006961 |
| County: | Russell |
| Place of Formation: | Russell County |
| Registered Office Street Address: | 5402 DUNBAR CIRCLEPHENIX CITY, AL 36867 |
| Registered Office Street Address ZIP Code: | 36867 |
Activities
PRACTICE OF PAIN MANAGEMENT/TREATMENT/RELATED SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356630792 | 2011-04-06 | 2023-10-23 | 1810 STADIUM DR, PHENIX CITY, AL, 368673177, US | 1810 STADIUM DR STE 140, PHENIX CITY, AL, 368673178, US | |||||||||||||||||||||||
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| Phone | +1 334-664-1969 |
| Fax | 8883912191 |
| Phone | +1 334-214-4616 |
| Fax | 3342144618 |
Authorized person
| Name | DR. BILL GENE BERRYMAN |
| Role | PHYSICIAN |
| Phone | 3342144616 |
Taxonomy
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| License Number | 26975 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BERRYMAN, BILL G | Organizer | 5402 DUNBAR CIRCLEPHENIX CITY, AL 36867 |
| RUSSELL, LEE M JR | Organizer | 150 SOUTH PERRY STREETMONTGOMERY, AL 36104 |
| Name | Role | Address |
|---|---|---|
| BERRYMAN, BILL G | Agent | 5402 DUNBAR CIRCLEPHENIX CITY, AL 36867 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
