| Name: | Adolescent and Adult Women's Healthcare of West Central Alabama LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 02 Apr 2013 (12 years ago) |
| Entity Number: | 000-074-583 |
| Register Number: | 000074583 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | 1023 MEDICAL CENTER PARKWAY STE 401SELMA, AL 36701 |
| Principal Address ZIP Code: | 36701 |
| Registered Office Street Address: | 212 W. TROY STREET, STE BDOTHAN, AL 36303 |
| Registered Office Street Address ZIP Code: | 36303 |
Activities
HEALTHCARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629318043 | 2013-02-21 | 2013-02-21 | 1023 MEDICAL CENTER PKWY, SUITE 401, SELMA, AL, 367016780, US | 1023 MEDICAL CENTER PKWY, SUITE 401, SELMA, AL, 367016780, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 334-875-7173 |
| Fax | 8668906112 |
Authorized person
| Name | DR. WILLIAM MICHAEL STEVENS |
| Role | PHYSICIAN |
| Phone | 3348757173 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | ST00991228 |
| State | AL |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT SERICE IN | Agent |
| Name | Role | Address |
|---|---|---|
| STEVENS, WILLIAM M | Organizer | 423 CHURCH STSELMA, AL 36701 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
