| Name: | Associated Medical Group, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 09 Jul 2002 (22 years ago) |
| Date of dissolution: | 16 Dec 2020 |
| Entity Number: | 000-224-039 |
| Register Number: | 000224039 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 907 EUCLID AVEBIRMINGHAM, AL 35213 |
| Registered Office Street Address ZIP Code: | 35213 |
| Authorized Capital: | $10,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588688246 | 2006-07-27 | 2007-09-09 | PO BOX 130070, BIRMINGHAM, AL, 352130070, US | 636 2ND ST NE, SUITE B, ALABASTER, AL, 35007, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-871-0050 |
| Fax | 2058710050 |
| Phone | +1 205-664-4377 |
| Fax | 2056643694 |
Authorized person
| Name | DR. LELAND N ALLEN III |
| Role | PRESIDENT |
| Phone | 2058710050 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 18247 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| License Number | 18247 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| License Number | 18247 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51004116 |
| State | AL |
| Name | Role |
|---|---|
| ALLEN, LELAND N | Agent |
| Name | Role | Address |
|---|---|---|
| SMITH, RALPH H II | Incorporator | 1819 5TH AVENUE NORTH SUITE 1100BIRMINGHAM, AL 35203 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
