| Name: | Lori Kaufman, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 24 Jun 1996 (28 years ago) |
| Date of dissolution: | 27 Dec 2021 |
| Entity Number: | 000-180-680 |
| Register Number: | 000180680 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | OWENS CROSS ROADS, AL |
| Registered Office Street Address: | 137 CATHERINE DROWENS CROSS ROADS, AL 35763 |
| Registered Office Street Address ZIP Code: | 35763 |
| Authorized Capital: | $10 |
| Paid Share Capital: | -- |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083898613 | 2007-12-18 | 2007-12-18 | 400 WHITESPORT DR SW, STE 201, HUNTSVILLE, AL, 358016452, US | 400 WHITESPORT DR SW, STE 201, HUNTSVILLE, AL, 358016452, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 256-882-9777 |
| Fax | 2568829188 |
Authorized person
| Name | LORI ELLEN KAUFMAN |
| Role | PRESIDENT |
| Phone | 2568829777 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 14161 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 4113939 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 81959 |
| State | AL |
| Issuer | UPIN |
| Number | C72458 |
| State | AL |
| Issuer | ALABAMA LICENSE |
| Number | 14161 |
| State | AL |
| Name | Role |
|---|---|
| KAUFMAN, LORI | Incorporator |
| Name | Role |
|---|---|
| KAUFMAN, LORI | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
