| Name: | Fairhope Internal Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 27 Mar 2003 (22 years ago) |
| Entity Number: | 000-228-359 |
| Register Number: | 000228359 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | 22790 HILLWOOD RDFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | 10,000 NPV |
Activities
MEDICAL PROFESSION
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295760494 | 2006-07-12 | 2024-07-24 | 6 MEDICAL PARK DRIVE, FAIRHOPE, AL, 36532, US | 6 MEDICAL PARK DRIVE, FAIRHOPE, AL, 36532, US | |||||||||||||||||||||
|
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| Phone | +1 251-990-1740 |
| Fax | 2519291886 |
Authorized person
| Name | FRANK WANG |
| Role | PHYSICIAN OWNER |
| Phone | 2519901740 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529917330 |
| State | AL |
| Name | Role |
|---|---|
| RAY, LAURA S | Agent |
| Name | Role |
|---|---|
| RAY, LAURA S | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
