| Name: | Piedmont Family Practice Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 Jan 1986 (39 years ago) (Companies founded in January 1986) |
| Entity Number: | 000-107-730 |
| Register Number: | 000107730 |
| Historical Names: |
Russell D. Ulrich, D.O., P.C.
|
| Place of Formation: | Calhoun County |
| Principal Address: | PIEDMONT, AL |
| Registered Office Street Address: | 800 W SMITH STPIEDMONT, AL |
| Authorized Capital: | $1,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700943602 | 2007-01-02 | 2021-01-28 | PO BOX 450, PIEDMONT, AL, 362720450, US | 25 ROUNDTREE DR, PIEDMONT, AL, 362725893, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-447-9045 |
| Fax | 2564479040 |
Authorized person
| Name | DR. RUSSELL DEAN ULRICH |
| Role | PRESIDENT |
| Phone | 2564479045 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| License Number | DO-47 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207QG0300X - Geriatric Medicine (Family Medicine) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528602460 |
| State | AL |
| Name | Role |
|---|---|
| ULRICH, RUSSELL D DO | Agent |
| Name | Role |
|---|---|
| ULRICH, RUSSELL D DO | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1986-05-30 | Name Change | Russell D. Ulrich, D.O., P.C. | Piedmont Family Practice Center, P.C. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
