| Name: | Impact Rehabilitation and Sports Medicine, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 06 Jun 2002 (22 years ago) |
| Entity Number: | 000-223-285 |
| Register Number: | 000223285 |
| County: | Shelby |
| Place of Formation: | Lee County |
| Principal Address: | CALERA, AL |
| Registered Office Street Address: | 413 SUMMERCHASE DRCALERA, AL 35040 |
| Registered Office Street Address ZIP Code: | 35040 |
| Authorized Capital: | $100 |
Activities
OPERATE A MEDICAL OFFICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497861926 | 2006-08-21 | 2009-04-22 | PO BOX 1694, CALERA, AL, 350401694, US | 101 CARRINGTON LN STE C, CALERA, AL, 350405439, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 205-621-3077 |
| Fax | 2056213788 |
Authorized person
| Name | MICHAEL CHADWICK |
| Role | OWNER |
| Phone | 2056213077 |
Taxonomy
| Taxonomy Code | 2251X0800X - Orthopedic Physical Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | HEALTH SPRING |
| Number | 50727 |
| State | AL |
| Issuer | CHRISTY BCBS |
| Number | 51534667 |
| State | AL |
| Issuer | TRI-CARE |
| Number | 438219695 |
| State | AL |
| Issuer | SUZI BCBS |
| Number | 51535738 |
| State | AL |
| Issuer | 7176438 |
| Number | AETNA |
| State | AL |
| Name | Role |
|---|---|
| CHADWICK, MICHAEL TRENT | Incorporator |
| BOREN, MICHAEL BRIAN | Incorporator |
| Name | Role |
|---|---|
| BOREN, MICHAEL BRIAN | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
