| Name: | Medical Associates of West Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Feb 1995 (30 years ago) |
| Entity Number: | 000-169-662 |
| Register Number: | 000169662 |
| Historical Names: |
Infectious Disease Consultants of West Alabama, P.C.
|
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 1100 NEWPORT DRTUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| Authorized Capital: | $2,000 |
| Paid Share Capital: | ---- |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619091725 | 2007-03-16 | 2018-03-15 | 809 UNIVERSITY BLVD E, TUSCALOOSA, AL, 354012029, US | 809 UNIVERSITY BLVD E, TUSCALOOSA, AL, 354012029, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 205-633-3541 |
Authorized person
| Name | DR. ALBERT T WHITE |
| Role | PHYSICIAN AND OWNER |
| Phone | 2056333541 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529502100 |
| State | AL |
| Name | Role |
|---|---|
| DOUGLAS, JEFF L | Agent |
| Name | Role |
|---|---|
| DOUGLAS, JEFF L | Incorporator |
| WHITE, ALBERT T | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1997-02-06 | Name Change | Infectious Disease Consultants of West Alabama, P.C. | Medical Associates of West Alabama, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
