| Name: | Alabama Urology Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 06 Jun 1978 (46 years ago) (Companies founded in June 1978) |
| Date of dissolution: | 16 Dec 2014 |
| Entity Number: | 000-052-664 |
| Register Number: | 000052664 |
| Historical Names: |
Stacy J. Childs, M.D., P.A.
Alabama Urology Associates, P.A. |
| ZIP code: | 35209 (Companies in Jefferson, 35209) |
| County: | Jefferson |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2022 BROOKWOOD MEDICAL CENTER DRBIRMINGHAM, AL 35209 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346205341 | 2006-04-20 | 2009-01-21 | 2022 BROOKWOOD MEDICAL CTR DR, ACC - SUITE 305, BIRMINGHAM, AL, 352096808, US | 2022 BROOKWOOD MEDICAL CTR DR, SUITE 305, BIRMINGHAM, AL, 352096808, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-877-2860 |
| Fax | 2058772733 |
Authorized person
| Name | DR. WILBUR GLEN WELLS JR. |
| Role | PRESIDENT |
| Phone | 2058772860 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 00008827 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000024112 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000004393 |
| State | AL |
| Name | Role |
|---|---|
| CHILDS, STACY J MD | Agent |
| Name | Role |
|---|---|
| CHILDS, STACY J MD | Incorporator |
| WELLS, W GLENN JR MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1985-08-02 | Name Change | Alabama Urology Associates, P.A. | Alabama Urology Associates, P.C. |
| 1981-01-18 | Name Change | Stacy J. Childs, M.D., P.A. | Alabama Urology Associates, P.A. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
