| Name: | Tuscaloosa Surgical Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Oct 2000 (24 years ago) |
| Entity Number: | 000-212-620 |
| Register Number: | 000212620 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 1837 COMMONS DR NTUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| Authorized Capital: | $1,000 |
Activities
TO RENDER PROFESSIONAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881614329 | 2006-07-20 | 2011-01-18 | 1837 COMMONS NORTH DR, TUSCALOOSA, AL, 354063700, US | 1837 COMMONS NORTH DR, TUSCALOOSA, AL, 354063700, US | |||||||||||||||||||||||||
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| Phone | +1 205-366-0696 |
| Fax | 2053661451 |
Authorized person
| Name | DR. WILLIAM LANGLEY PRIDGEN |
| Role | PRESIDENT |
| Phone | 2053660696 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 22573 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1881614329 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PRIDGEN, WILLIAM L | Agent | 1837 COMMONS DRIVE NORTHTUSCALOOSA, AL 35406 |
| Name | Role | Address |
|---|---|---|
| PRIDGEN, WILLIAM L | Incorporator | 1837 COMMONS DRIVE NORTHTUSCALOOSA, AL 35406 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
