| Name: | West Alabama Family Practice & Sports Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 25 Jan 1995 (30 years ago) (Companies founded in January 1995) |
| Entity Number: | 000-169-672 |
| Register Number: | 000169672 |
| ZIP code: | 35406 (Companies in Tuscaloosa, 35406) |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | NORTHPORT, AL |
| Registered Office Street Address: | 100 RICE MINE ROAD LOOP SUITE 206TUSCALOOSA, AL 35406 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | ---- |
Activities
RENDER PROFESSIONAL MEDICAL SERVICES/FAMILY & SPORTS MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174112361 | 2021-01-13 | 2021-01-15 | 7094 FOREST MILL DR, COTTONDALE, AL, 354531446, US | 100 RICE MINE ROAD LOOP STE 206, TUSCALOOSA, AL, 354062418, US | |||||||||||||
|
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| Phone | +1 205-339-0171 |
Authorized person
| Name | MICHELLE HAWTHORNE |
| Role | BILLING MANAGER |
| Phone | 2052922428 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
| Name | Role |
|---|---|
| LAUBENTHAL, JEFFERY C | Agent |
| Name | Role |
|---|---|
| ROBINSON, JAMES B | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
