| Name: | William R. Jordan, M.D., LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 09 Feb 2012 (13 years ago) (Companies founded in February 2012) |
| Date of dissolution: | 06 Jun 2017 |
| Entity Number: | 000-040-570 |
| Register Number: | 000040570 |
| ZIP code: | 36877 (Companies in Lee, 36877) |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | 33 LEE ROAD #610SMITHS, AL 36877 |
| Registered Office Street Address: | 5701 GLOYD POINT WAYPHENIX CITY, AL 36867 |
Activities
PRACTICE OF MEDICINE
NAMELY GYNECOLOGICAL
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689922205 | 2012-08-29 | 2012-08-29 | 1212 7TH AVE STE B, PHENIX CITY, AL, 368675805, US | 1212 7TH AVE STE B, PHENIX CITY, AL, 368675805, US | |||||||||||||||||||||||||
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| Phone | +1 334-297-7790 |
| Fax | 3342977127 |
Authorized person
| Name | DR. WILLIAM RICHIE JORDAN |
| Role | PHYSICIAN-OWNER |
| Phone | 3342977790 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207VG0400X - Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1790768646 |
| State | AL |
| Name | Role |
|---|---|
| CROSS, AMERICA A | Agent |
| Name | Role | Address |
|---|---|---|
| JORDAN, WILLIAM R | Organizer | 33 LEE ROAD #610SMITHS, AL 36877 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
