| Name: | Fowler Sports Medicine and Orthopaedics, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 29 Feb 1988 (37 years ago) |
| Date of dissolution: | 18 Apr 2011 |
| Entity Number: | 000-122-519 |
| Register Number: | 000122519 |
| Historical Names: |
H. Leslie Fowler, M.D., P.C.
|
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 600 UNIVERSITY BLVDTUSCALOOSA, AL |
| Authorized Capital: | $5,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366407199 | 2006-04-17 | 2009-03-17 | 100 RICE MINE ROAD LOOP, SUITE 205, TUSCALOOSA, AL, 354062419, US | 100 RICE MINE ROAD LOOP, SUITE 205, TUSCALOOSA, AL, 354062419, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 205-752-1800 |
| Fax | 2057521891 |
Authorized person
| Name | DR. HOWARD LESLIE FOWLER |
| Role | PRESIDENT |
| Phone | 2057521800 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529002300 |
| State | AL |
| Name | Role |
|---|---|
| FOWLER, H LESLIE MD | Agent |
| Name | Role |
|---|---|
| FOWLER, H LESLIE MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1990-05-17 | Name Change | H. Leslie Fowler, M.D., P.C. | Fowler Sports Medicine and Orthopaedics, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
