| Name: | Southern Family Practice and Occupational Medicine, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 17 Jul 1992 (32 years ago) |
| Entity Number: | 000-150-856 |
| Register Number: | 000150856 |
| Historical Names: |
Urgent Care of North Alabama, Inc.
|
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Principal Address: | ANNISTON, AL |
| Registered Office Street Address: | 1408 LEIGHTON AVENUEANNISTON, AL 36201 |
| Registered Office Street Address ZIP Code: | 36201 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326077108 | 2006-07-02 | 2010-02-23 | PO BOX 457, ANNISTON, AL, 362020457, US | 700 QUINTARD AVE, ANNISTON, AL, 362015758, US | |||||||||||||||||||||||||
|
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| Phone | +1 256-236-9400 |
| Fax | 2562381498 |
Authorized person
| Name | DONALD WAYNE CASEY |
| Role | PRESIDENT |
| Phone | 2562369400 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | DO-113 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1063444099 |
| State | AL |
| Name | Role |
|---|---|
| CASEY, BONNIE M | Agent |
| Name | Role |
|---|---|
| CASEY, BONNIE M | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2003-03-21 | Name Merged | No data | Alabama Industrial Medicine , Inc. |
| 2003-03-21 | Name Change | Urgent Care of North Alabama, Inc. | Southern Family Practice and Occupational Medicine, Inc. |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PO | AWARD | W911KF11V0015 | 2011-07-20 | 2011-09-30 | 2011-09-30 | |||||||||||||||||||||
|
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| Title | FUNDING |
| NAICS Code | 621111: OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS) |
| Product and Service Codes | Q301: LABORATORY TESTING SERVICES |
Recipient Details
| Recipient | SOUTHERN FAMILY PRACTICE AND OCCUPATIONAL MEDICINE, INC. |
| UEI | NKABGYYMGHL5 |
| Legacy DUNS | 931461016 |
| Recipient Address | UNITED STATES, 700 QUINTARD AVE, ANNISTON, 362015758 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
