| Name: | Innova Primary Care, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 Jun 2011 (13 years ago) |
| Entity Number: | 000-018-811 |
| Register Number: | 000018811 |
| Historical Names: |
Brooke R. Uptagrafft, M.D., P.C.
BrookeMD, P.C. |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | 247 Chateau DriveHuntsville, AL 35801 |
| Principal Address ZIP Code: | 35801 |
| Registered Office Street Address: | 247 CHATEAU DRIVEHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | 2,000@ $1PV |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689954240 | 2011-08-26 | 2023-07-12 | 247 CHATEAU DR SW, HUNTSVILLE, AL, 358016401, US | 247 CHATEAU DR SW, HUNTSVILLE, AL, 358016401, US | |||||||||||||||||||||
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| Phone | +1 256-882-1510 |
| Fax | 2562175838 |
Authorized person
| Name | BROOKE R UPTAGRAFFT |
| Role | PHYSICIAN |
| Phone | 2568821510 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PENDING |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| INNOVA PRIMARY CARE, P. C., 401(K) PROFIT SHARING PLAN | 2023 | 452704915 | 2024-10-14 | INNOVA PRIMARY CARE, P.C. | 32 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| UPTAGRAFFT, BROOKE R | Director | 247 CHATEAU DRIVEHUNTSVILLE, AL 35801 |
| Name | Role | Address |
|---|---|---|
| UPTAGRAFFT, BROOKE R | Incorporator | 247 CHATEAU DRIVEHUNTSVILLE, AL 35801 |
| Name | Role | Address |
|---|---|---|
| UPTAGRAFFT, BROOKE R | Agent | 247 CHATEAU DRIVEHUNTSVILLE, AL 35801 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2016-11-22 | Name Change | BrookeMD, P.C. | Innova Primary Care, P.C. |
| 2015-11-30 | Name Change | Brooke R. Uptagrafft, M.D., P.C. | BrookeMD, P.C. |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
