| Name: | ROYSE FAMILY MEDICINE, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 14 May 2012 (13 years ago) |
| Entity Number: | 000-057-411 |
| Register Number: | 000057411 |
| County: | Limestone |
| Place of Formation: | Limestone County |
| Principal Address: | 727 W MARKET ST., SUITE DATHENS, AL 35611 |
| Principal Address ZIP Code: | 35611 |
| Authorized Capital: | 1000 |
Activities
PRACTICE/RENDER PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063771053 | 2012-05-10 | 2012-06-26 | 727 W MARKET ST, SUITE D, ATHENS, AL, 356112456, US | 727 W MARKET ST, SUITE D, ATHENS, AL, 356112456, US | |||||||||||||||||||||||||
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| Phone | +1 256-233-5145 |
| Fax | 2562302615 |
Authorized person
| Name | JOHN C ROYSE |
| Role | OWNER |
| Phone | 2562335145 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 00025382 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 138775 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| ROYSE, JOHN C | Director | 727 W MARKET ST., SUITE DATHENS, AL 35611 |
| Name | Role | Address |
|---|---|---|
| ROYSE, JOHN C | Incorporator | 727 W MARKET ST., SUITE DATHENS, AL 35611 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
