| Name: | Alabama Geriatric Specialists, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 13 Jun 2000 (24 years ago) |
| Date of dissolution: | 17 Dec 2022 |
| Entity Number: | 000-210-431 |
| Register Number: | 000210431 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 4303 CLAIRMONT AVE SBIRMINGHAM, AL 35222 |
| Registered Office Street Address ZIP Code: | 35222 |
| Authorized Capital: | $1,000 |
Activities
GERIATRIC MEDICAL SEVICES/CONSULTING
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669494597 | 2006-07-23 | 2022-09-08 | PO BOX 130776, BIRMINGHAM, AL, 352130776, US | 1 W LAKESHORE DR STE 100, BIRMINGHAM, AL, 352097271, US | |||||||||||||||||||||||||
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| Phone | +1 205-916-0105 |
| Fax | 2057188934 |
Authorized person
| Name | MR. PAUL D ROLLER |
| Role | OWNER/PHYSICIAN |
| Phone | 2059160105 |
Taxonomy
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529912710 |
| State | AL |
| Issuer | RAILROAD MEDICARE GROUP # |
| Number | DA7932 |
| Name | Role |
|---|---|
| ROLLER, PAUL D | Agent |
| Name | Role |
|---|---|
| ROLLER, PAUL D | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
