| Name: | Shoals Orthopedics and Sports Medicine, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 10 Apr 2002 (23 years ago) |
| Date of dissolution: | 23 Nov 2021 |
| Entity Number: | 000-222-312 |
| Register Number: | 000222312 |
| Historical Names: |
Shoals Orthopedics, P.C.
|
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Principal Address: | FLORENCE, AL |
| Registered Office Street Address: | 730 NORTH WOOD AVEFLORENCE, AL 35630 |
| Registered Office Street Address ZIP Code: | 35630 |
| Authorized Capital: | $100 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194073395 | 2012-08-17 | 2012-08-17 | 426 W COLLEGE ST, FLORENCE, AL, 356305521, US | 426 W COLLEGE ST, FLORENCE, AL, 356305521, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 256-718-4041 |
| Fax | 2567183665 |
Authorized person
| Name | LEE NICHOLS JR. |
| Role | PRESIDENT |
| Phone | 2567184041 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529911910 |
| State | AL |
| Issuer | MEDCIARE DMERC |
| Number | 4562760001 |
| State | AL |
| Name | Role |
|---|---|
| NICHOLS, R LEE | Agent |
| Name | Role |
|---|---|
| NICHOLS, R LEE | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2007-02-08 | Name Change | Shoals Orthopedics, P.C. | Shoals Orthopedics and Sports Medicine, PC |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
