| Name: | Eufaula Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 16 Mar 2001 (24 years ago) |
| Date of dissolution: | 29 Dec 2011 |
| Entity Number: | 000-215-410 |
| Register Number: | 000215410 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | MADISON, AL |
| Registered Office Street Address: | 111 LEA CIRCLEMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023216801 | 2007-07-03 | 2020-08-22 | 617 E BROAD ST, B, EUFAULA, AL, 36027, US | 617 E BROAD ST, B, EUFAULA, AL, 36027, US | |||||||||||||||||||
|
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| Phone | +1 334-687-0112 |
| Fax | 3346870113 |
Authorized person
| Name | RICHARD SHACK |
| Role | OWNER |
| Phone | 3346870112 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 22858 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| SHACK, RICHARD K JR | Incorporator |
| Name | Role |
|---|---|
| SHACK, RICHARD K JR | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
