| Name: | Shoals Medical Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 26 Apr 1994 (31 years ago) |
| Date of dissolution: | 04 Oct 2017 |
| Entity Number: | 000-163-825 |
| Register Number: | 000163825 |
| Historical Names: |
The Primary Care Center, P.C.
|
| County: | Colbert |
| Place of Formation: | Colbert County |
| Principal Address: | TUSCUMBIA, AL |
| Registered Office Street Address: | 1404 E AVALON AVETUSCUMBIA, AL 35674 |
| Registered Office Street Address ZIP Code: | 35674 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
ENGAGE IN THE PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407056252 | 2007-07-19 | 2007-07-19 | 1404 E AVALON AVE, SUITE B-00, TUSCUMBIA, AL, 356741773, US | 1404 E AVALON AVE, SUITE B-00, TUSCUMBIA, AL, 356741773, US | |||||||||||||||||||||||||
|
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| Phone | +1 256-381-5234 |
| Fax | 2563815232 |
Authorized person
| Name | DR. DAVID BRUCE LAUGHLIN |
| Role | PRESIDENT |
| Phone | 2563815234 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 18096 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 24815 |
| State | AL |
| Name | Role |
|---|---|
| LAUGHLIN, BRUCE MD | Agent |
| Name | Role |
|---|---|
| EVANS, GEORGE A MD | Incorporator |
| MARTIN, TIMOTHY L SR MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2005-12-21 | Name Merged | No data | D. B. Laughlin, M.D., P.C. |
| 1999-06-23 | Name Change | The Primary Care Center, P.C. | Shoals Medical Clinic, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
