| Name: | Specialty Clinic, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 14 Sep 1998 (26 years ago) (Companies founded in September 1998) |
| Entity Number: | 000-197-811 |
| Register Number: | 000197811 |
| Historical Names: |
Covington Family Care, P.C.
|
| ZIP code: | 36420 (Companies in Covington, 36420) |
| County: | Covington |
| Place of Formation: | Covington County |
| Registered Office Street Address: | 700 N BRANTLEYOPP, AL 36467 |
| Principal Address: | 508 EAST THREE NOTCH STREETANDALUSIA, AL 36420 |
| Authorized Capital: | $5,000 |
Activities
PRACTICE OF MEDICINE/SURGERY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427263227 | 2007-05-14 | 2017-10-02 | PO BOX 310, ANDALUSIA, AL, 364201205, US | 508 E THREE NOTCH ST, ANDALUSIA, AL, 364203128, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 334-472-9427 |
| Fax | 3342222183 |
Authorized person
| Name | DR. ROGER T BOYINGTON |
| Role | OWNER, PHYSICIAN |
| Phone | 3344272273 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | DO439 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529901030 |
| State | AL |
| Issuer | ALABAMA BLUE CROSS |
| Number | 051078763 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BOYINGTON, ROGER T | Agent | 508 EAST THREE NOTCH STREETANDALUSIA, AL 36420 |
| Name | Role | Address |
|---|---|---|
| BOYINGTON, ROGER T | Incorporator | 508 EAST THREE NOTCH STREETANDALUSIA, AL 36420 |
| Name | Role | Address |
|---|---|---|
| BOYINGTON, ROGER T | Director | 508 EAST THREE NOTCH STREETANDALUSIA, AL 36420 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2017-10-03 | Name Change | Covington Family Care, P.C. | Specialty Clinic, PC |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
