| Name: | TriCounty Family Practice, P. C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 05 Feb 2000 (25 years ago) |
| Entity Number: | 000-208-040 |
| Register Number: | 000208040 |
| County: | Randolph |
| Place of Formation: | Randolph County |
| Principal Address: | ROANOKE, AL |
| Registered Office Street Address: | 469 PRICE STROANOKE, AL 36274 |
| Registered Office Street Address ZIP Code: | 36274 |
| Authorized Capital: | $500 |
Activities
PROVIDE PROFESSIONAL MEDICAL SERVICES
| 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 | |||||||||||||||||||||||||
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| 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 |
| Name | Role |
|---|---|
| JOHNSON, TIFFANY D | Agent |
| 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
