| Name: | Opp Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 14 May 1999 (26 years ago) |
| Entity Number: | 000-202-699 |
| Register Number: | 000202699 |
| County: | Covington |
| Place of Formation: | Covington County |
| Principal Address: | OPP, AL |
| Registered Office Street Address: | 604 N BRANTLEY STOPP, AL 36467 |
| Registered Office Street Address ZIP Code: | 36467 |
| Authorized Capital: | $5,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891989117 | 2007-08-29 | 2007-08-29 | PO BOX 280, OPP, AL, 364670280, US | 604 BRANTLEY ST, OPP, AL, 364671742, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-493-4472 |
| Fax | 3344939849 |
Authorized person
| Name | DR. J MICHAEL STANFIELD |
| Role | PRESIDENT |
| Phone | 3344934472 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 21062 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 21063 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | H551 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 510 |
| State | AL |
| Name | Role |
|---|---|
| STANFIELD, JONATHAN MICHAEL | Agent |
| Name | Role |
|---|---|
| STANFIELD, JONATHAN MICHAEL | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
