| Name: | Pickens County Family Practice Center, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 28 Feb 1986 (39 years ago) (Companies founded in February 1986) |
| Entity Number: | 000-109-035 |
| Register Number: | 000109035 |
| ZIP code: | 35466 (Companies in Pickens, 35466) |
| County: | Pickens |
| Place of Formation: | Pickens County |
| Principal Address: | GORDO, AL |
| Registered Office Street Address: | HIGHWAY 86 NORTHGORDO, AL 35466 |
| Authorized Capital: | $5,000 |
Activities
MEDICAL FAMILY PRACTICE CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174675144 | 2007-01-18 | 2007-12-18 | 27340 HIGHWAY 86, GORDO, AL, 35466, US | 27340 HWY 86, GORDO, AL, 354667340, US | |||||||||||||||||||||||
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| Phone | +1 205-364-7135 |
Authorized person
| Name | DR. JOHN BRANDON |
| Role | PRESIDENT |
| Phone | 2053647135 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 8876 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000015657 |
| State | AL |
| Name | Role |
|---|---|
| BRANDON, JOHN E | Agent |
| Name | Role |
|---|---|
| BRANDON, JOHN E | Incorporator |
| CADLE, RODNEY RAY | Incorporator |
| SHEPPARD, A ROBERT | Incorporator |
| BROOKE, WILLIAM R | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
