| Name: | West Alabama Nephrology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 29 Jun 1995 (29 years ago) |
| Entity Number: | 000-172-866 |
| Register Number: | 000172866 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 1400 DIAMOND POINT CIRCLETUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
Activities
RENDER PROFESSIONAL MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225197197 | 2006-12-07 | 2015-05-13 | 4400 WATERMELON RD, SUITE B, NORTHPORT, AL, 354735204, US | 4400 WATERMELON RD, SUITE B, NORTHPORT, AL, 354735204, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-345-6302 |
| Fax | 2052474300 |
Authorized person
| Name | DR. GEOFFREY N ALILONU |
| Role | OWNER |
| Phone | 2053456302 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 9748 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 103380 |
| State | AL |
| Issuer | AL LICENSE |
| Number | 28996 |
| State | AL |
| Issuer | BCBS NUMBER |
| Number | 51591962 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000037267 |
| State | AL |
| Issuer | BCBS |
| Number | 51037267 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529603880 |
| State | AL |
| Issuer | AL LICENSE |
| Number | 9748 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| ALILONU, GEOFFREY | Agent | 1400 DIAMOND POINT CIRCLETUSCALOOSA, AL 35406 |
| Name | Role | Address |
|---|---|---|
| ALILONU, GEOFFREY N | Director | 1400 DIAMOND POINT CIRCLETUSCALOOSA, AL 35406 |
| Name | Role |
|---|---|
| ROBARDS, MICHAEL P | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
