| Name: | Tennessee Valley Internal Medicine P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 09 Nov 2011 (13 years ago) |
| Entity Number: | 000-030-158 |
| Register Number: | 000030158 |
| County: | Madison |
| Place of Formation: | Madison County |
| Registered Office Street Address: | 205 WHITE PICKET TRAILMERIDIANVILLE, AL 35759 |
| Registered Office Street Address ZIP Code: | 35759 |
| Authorized Capital: | 1000 @ $1 PV |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174892780 | 2011-12-28 | 2012-04-18 | 3809 SULLIVAN ST, SUITE 7, MADISON, AL, 357582372, US | 3809 SULLIVAN ST, SUITE 7, MADISON, AL, 357582372, US | |||||||||||||||||||||
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| Phone | +1 256-428-1096 |
| Fax | 2564281097 |
Authorized person
| Name | NICHOLAS A PATELLIS |
| Role | PHYSICIAN/OWNER |
| Phone | 2565094010 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 136258 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PATELLIS, NICHOLAS A | Agent | 205 WHITE PICKET TRAILMERIDIANVILLE, AL 35759 |
| Name | Role | Address |
|---|---|---|
| PATELLIS, NICHOLAS A | Director | 205 WHITE PICKET TRAILMERIDIANVILLE, AL 35759 |
| PATELLIS, APRIL M | Director | 205 WHITE PICKET TRAILMERIDIANVILLE, AL 35759 |
| Name | Role | Address |
|---|---|---|
| PATELLIS, NICHOLAS A | Incorporator | 205 WHITE PICKET TRAILMERIDIANVILLE, AL 35759 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
