| Name: | Family Medicine Associates of East Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Mar 1990 (35 years ago) |
| Entity Number: | 000-135-751 |
| Register Number: | 000135751 |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | OPELIKA, AL |
| Registered Office Street Address: | 121 N 20TH STREET #24OPELIKA, AL 36801 |
| Registered Office Street Address ZIP Code: | 36801 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $600 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588726616 | 2006-12-14 | 2022-01-21 | 122 N 20TH ST BLDG 24, OPELIKA, AL, 368015442, US | 122 N 20TH ST BLDG 24, OPELIKA, AL, 368015442, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-745-4646 |
| Fax | 3347450633 |
Authorized person
| Name | BRIAN EDWARD ROGERS |
| Role | OWNER/VICE PRESIDENT |
| Phone | 3347454646 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 7477 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528902200 |
| State | AL |
| Issuer | BCBS PROVIDER # |
| Number | 51076478 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FAMILY MEDICINE ASSOCIATES OF EAST ALABAMA, P.C. 401(K) PLAN | 2009 | 631014232 | 2010-06-22 | FAMILY MEDICINE ASSOCIATES OF EAST ALABAMA, P.C. | 24 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 631014232 |
| Plan administrator’s name | FAMILY MEDICINE ASSOCIATES OF EAST ALABAMA, P.C. |
| Plan administrator’s address | 122 NORTH 20TH ST., BLDG. 24, OPELIKA, AL, 36801 |
| Administrator’s telephone number | 3347454646 |
Signature of
| Role | Plan administrator |
| Date | 2010-06-22 |
| Name of individual signing | WILLIAM B. WHATLEY, III, M.D. |
| Name | Role |
|---|---|
| WHATLEY, W B III | Agent |
| Name | Role |
|---|---|
| WHATLEY, W B III | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
