| Name: | Stevenson Medical Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 Apr 1999 (26 years ago) (Companies founded in April 1999) |
| Entity Number: | 000-202-458 |
| Register Number: | 000202458 |
| ZIP code: | 35772 (Companies in Jackson, 35772) |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Address: | STEVENSON, AL |
| Registered Office Street Address: | 196 COUNTY RD 85STEVENSON, AL 35772 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
ENGAGE IN PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033202320 | 2006-10-02 | 2018-06-21 | 196 COUNTY ROAD 85, STEVENSON, AL, 357725522, US | 196 COUNTY ROAD 85, STEVENSON, AL, 357725522, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-437-2272 |
| Fax | 2564372273 |
Authorized person
| Name | DR. ALAN J WAYNE |
| Role | CEO |
| Phone | 2564372272 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 013785 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE# |
| Number | 013785 |
| State | AL |
| Issuer | LICENSE# |
| Number | 42529 |
| State | TN |
| Issuer | MEDICAID |
| Number | 009957765 |
| State | AL |
| Name | Role |
|---|---|
| WAYNE, ALAN J | Agent |
| Name | Role |
|---|---|
| WAYNE, ALAN J | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
