| Name: | Selma Radiology Associates, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 28 Mar 2003 (22 years ago) |
| Entity Number: | 000-228-270 |
| Register Number: | 000228270 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2055 NORMANDIE DRIVE, SUITE 110MONTGOMERY, AL 36111 |
| Registered Office Street Address ZIP Code: | 36111 |
| Authorized Capital: | $5,000 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669429296 | 2006-05-28 | 2023-03-22 | 2055 NORMANDIE DR STE 200, MONTGOMERY, AL, 361112732, US | 2055 NORMANDIE DR, SUITE 108, MONTGOMERY, AL, 361112732, US | |||||||||||||||||||||
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| Phone | +1 334-269-6337 |
| Fax | 3348340657 |
Authorized person
| Name | MR. MARK D LAURENT |
| Role | CEO |
| Phone | 3342884624 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529915030 |
| State | AL |
| Name | Role |
|---|---|
| LEQUIRE, MARK H | Agent |
| Name | Role | Address |
|---|---|---|
| JOHNSON, D KYLE | Incorporator | 150 S PERRY STMONTGOMERY, AL 36104 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
