| Name: | Obstetrics and Gynecology of West Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 27 Jul 1983 (41 years ago) |
| Entity Number: | 000-093-291 |
| Register Number: | 000093291 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 100 RICE MINE RDTUSCALOOSA, AL 35401 |
| Registered Office Street Address ZIP Code: | 35401 |
| Authorized Capital: | $5,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316912934 | 2006-02-17 | 2011-08-08 | 2750 HOSPITAL DR, NORTHPORT, AL, 354763360, US | 2750 HOSPITAL DR, NORTHPORT, AL, 354763360, US | |||||||||||||||||||||||||
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| Phone | +1 205-339-3039 |
| Fax | 2053399908 |
Authorized person
| Name | STEPHEN E ALLEN |
| Role | EMPLOYER |
| Phone | 2053393039 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 17027 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 00028095 |
| State | AL |
| Name | Role |
|---|---|
| BRYARS, GORDON COMPTON MD | Agent |
| Name | Role |
|---|---|
| BRYARS, GORDON COMPTON MD | Incorporator |
| REED, MARION DOUGLAS JR MD | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
