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West Alabama Pediatrics, Inc.

Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
PETITT, BRUCE A Agent 1060 FAIRFAX PARK SUITE CTUSCALOOSA, AL 35406

Incorporator

Name Role Address
PETITT, BRUCE A Incorporator 1060 FAIRFAX PARK SUITE CTUSCALOOSA, AL 35406

Events

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