| Name: | Pediatric Associates of Auburn, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 Jul 1990 (34 years ago) |
| Entity Number: | 000-137-863 |
| Register Number: | 000137863 |
| Historical Names: |
Drs. Freeman and Anz, P.C.
|
| County: | Lee |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 411 B OPELIKA ROADAUBURN,, AL 36830 |
| Registered Office Street Address ZIP Code: | 36830 |
| Authorized Capital: | $3,000 |
| Paid Share Capital: | $2,000 |
Activities
PEDIATRIC AND ADOLESCENT MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316099203 | 2007-01-18 | 2021-07-12 | 2901 CORPORATE PARK DRIVE, OPELIKA, AL, 368017283, US | 2901 CORPORATE PARK DR, OPELIKA, AL, 368017283, US | |||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-203-1766 |
| Fax | 3342031784 |
Authorized person
| Name | MRS. DIANNE MARTINEZ CARLTON |
| Role | OFFICE MANAGER |
| Phone | 3342031766 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| License Number | 5738 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528201420 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000044755 |
| State | AL |
| Issuer | BCBS RICHARD M. FREEMAN, |
| Number | 51002165 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000002165 |
| State | AL |
| Issuer | BCBS ELLEN L. ROYAL, M.D. |
| Number | 51044755 |
| State | AL |
| Name | Role |
|---|---|
| FREEMAN, RICHARD M | Agent |
| Name | Role |
|---|---|
| ANZ, LINDA H | Incorporator |
| FREEMAN, RICHARD M | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2014-02-26 | Name Change | Drs. Freeman and Anz, P.C. | Pediatric Associates of Auburn, PC |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
