| Name: | Troy Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 Aug 1999 (25 years ago) (Companies founded in August 1999) |
| Entity Number: | 000-204-249 |
| Register Number: | 000204249 |
| ZIP code: | 36081 (Companies in Pike, 36081) |
| County: | Pike |
| Place of Formation: | Pike County |
| Principal Address: | TROY, AL |
| Registered Office Street Address: | 1320 HWY 231 SOUTH STE 4TROY, AL 36081 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE FAMILY MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255481677 | 2007-01-10 | 2019-01-23 | 101 COUNTRY CLUB RD, TROY, AL, 360793093, US | 101 COUNTRY CLUB RD, TROY, AL, 360793093, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-807-0235 |
| Fax | 3348070099 |
Authorized person
| Name | DR. PHYLECYA YVETTE CHEATHAM |
| Role | PRESIDENT |
| Phone | 3348070235 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 00019306 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | CLEA |
| Number | 01D0961776 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000044674 |
| State | AL |
| Issuer | BLUE CROSS PROVIDER # |
| Number | 51044674 |
| State | AL |
| Name | Role |
|---|---|
| CHEATHAM, PHYLECYA Y | Agent |
| Name | Role | Address |
|---|---|---|
| LEVITT, RONALD A | Incorporator | PO BOX 55727BIRMINGHAM, AL 35255-5727 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
