| Name: | Pediatric Adolescent Medicine, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 10 Mar 2000 (25 years ago) |
| Entity Number: | 000-208-350 |
| Register Number: | 000208350 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | SELMA, AL |
| Registered Office Street Address: | 1107 VOEGLIN AVE STE 202SELMA, AL 36701 |
| Registered Office Street Address ZIP Code: | 36701 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PROVIDE PEDIATRIC/ADOLESCENT MEDICAL PRACTICE/HEALTHCARE SERVICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902975899 | 2006-11-07 | 2020-08-22 | 1107 VOEGLIN AVE, SUITE 202, SELMA, AL, 367034301, US | 1107 VOEGLIN AVE, SUITE 202, SELMA, AL, 367034301, US | |||||||||||||||||||||||||
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| Phone | +1 334-874-4843 |
| Fax | 3348749598 |
Authorized person
| Name | MRS. PATRICIA ANN KENDRICK-ROBINSON |
| Role | M.D. |
| Phone | 3348744843 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| License Number | 14314 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51500362 |
| State | AL |
| Name | Role |
|---|---|
| KENDRICK-MILLER, PATRICIA ANN | Agent |
| Name | Role |
|---|---|
| KENDRICK, PATRICIA ANN MILLER | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
