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TriCounty Family Practice, P. C.

Details

Name: TriCounty Family Practice, P. C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 05 Feb 2000 (25 years ago) (Companies founded in February 2000)
Entity Number: 000-208-040
Register Number: 000208040
ZIP code: 36274 (Companies in Randolph, 36274)
County: Randolph
Place of Formation: Randolph County
Principal Address: ROANOKE, AL
Registered Office Street Address: 469 PRICE STROANOKE, AL 36274
Authorized Capital: $500

Activities PROVIDE PROFESSIONAL MEDICAL SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1891897948 2006-09-01 2008-12-16 149 CHESTNUT ST, ROANOKE, AL, 362741301, US 149 CHESTNUT ST, ROANOKE, AL, 362741301, US

Contacts

Phone +1 334-863-5484
Fax 3348635481

Authorized person

Name DR. ABAYOMI G OSHINOWO
Role MEDICAL DIRECTOR
Phone 3348635484

Taxonomy

Taxonomy Code 207Q00000X - Family Medicine Physician
License Number 20466
State AL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 529904460
State AL

Agent

Name Role
JOHNSON, TIFFANY D Agent

Incorporator

Name Role Address
MEADORS, E DREXEL Incorporator 607 AVENUE EWEST POINT, GA 31833

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State