| Name: | North Shelby Family Health, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 20 Oct 1995 (29 years ago) |
| Entity Number: | 000-175-161 |
| Register Number: | 000175161 |
| County: | Jefferson |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 2520 VALLEYDALE ROADBIRMINGHAM, AL 35244 |
| Registered Office Street Address ZIP Code: | 35244 |
| Authorized Capital: | $5,000 |
Activities
MEDICAL PRACTICE; SPECIALIZING IN FAMILY PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508976598 | 2006-08-30 | 2010-10-18 | 2520 VALLEYDALE RD, BIRMINGHAM, AL, 352442019, US | 2520 VALLEYDALE RD, BIRMINGHAM, AL, 352442019, US | |||||||||||||||||||||
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| Phone | +1 205-980-9944 |
| Fax | 2059809844 |
Authorized person
| Name | MRS. CAROL J SIMS |
| Role | OFFICE MANAGER |
| Phone | 2059809944 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529700260 |
| State | AL |
| Name | Role |
|---|---|
| MOORE, DOUGLAS O | Agent |
| Name | Role |
|---|---|
| MOORE, DOUGLAS O | Incorporator |
| BLACKBURN, VANCE G | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
