| Name: | West Alabama Pediatrics, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 31 Jul 1998 (26 years ago) |
| Entity Number: | 000-197-262 |
| Register Number: | 000197262 |
| Historical Names: |
Bruce A. Petitt, M.D., P.C.
|
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 1800 RICE MINE RDTUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| Authorized Capital: | $5,000 |
Activities
PRACTICE PEDIATRIC MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013077205 | 2006-12-11 | 2010-12-14 | 1060 FAIRFAX PARK, SUITE C, TUSCALOOSA, AL, 354062806, US | 1060 FAIRFAX PARK, SUITE C, TUSCALOOSA, AL, 354062806, US | |||||||||||||||||||||
|
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| Phone | +1 205-752-7337 |
| Fax | 2057528013 |
Authorized person
| Name | DR. BRUCE A PETITT |
| Role | PHYSICIAN OWNER |
| Phone | 2057527337 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104775 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PETITT, BRUCE A | Agent | 1060 FAIRFAX PARK SUITE CTUSCALOOSA, AL 35406 |
| Name | Role | Address |
|---|---|---|
| PETITT, BRUCE A | Incorporator | 1060 FAIRFAX PARK SUITE CTUSCALOOSA, AL 35406 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2021-01-28 | Name Change | Bruce A. Petitt, M.D., P.C. | West Alabama Pediatrics, Inc. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
