| Name: | Madison Family Practice Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 05 Jan 1996 (29 years ago) |
| Entity Number: | 000-176-898 |
| Register Number: | 000176898 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | MADISON, AL |
| Registered Office Street Address: | 7193-D HWY 72 WESTMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295978559 | 2009-04-15 | 2009-04-15 | 8371 HWY 72 WEST, SUITE 100, MADISON, AL, 35758, US | 8371 HWY 72 WEST, SUITE 100, MADISON, AL, 35758, US | |||||||||||||||||||||||||
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| Phone | +1 256-430-0030 |
| Fax | 2567210408 |
Authorized person
| Name | DR. THOMAS SCOTT ROYSTER |
| Role | OWNER & PHYSICIAN |
| Phone | 2564300030 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 13590 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 510-19621 |
| State | AL |
| Name | Role |
|---|---|
| ROYSTER, THOMAS SCOTT | Agent |
| Name | Role |
|---|---|
| ROYSTER, THOMAS SCOTT | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
