| Name: | Taylor Internal Medicine of Selma, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 30 May 2003 (21 years ago) |
| Entity Number: | 000-229-277 |
| Register Number: | 000229277 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | SELMA, AL |
| Registered Office Street Address: | 4258 US HIGHWAY 80 WESTSELMA, AL 36701 |
| Registered Office Street Address ZIP Code: | 36701 |
| Authorized Capital: | $100 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114013315 | 2006-10-05 | 2009-01-06 | 4258 US HIGHWAY 80 W, SELMA, AL, 367012202, US | 4258 US HIGHWAY 80 W, SELMA, AL, 367012202, US | |||||||||||||||||||||||||
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| Phone | +1 334-874-8800 |
| Fax | 3348747700 |
Authorized person
| Name | BRUCE EDWARD TAYLOR |
| Role | PHYSICIAN |
| Phone | 3348748800 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 24464 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529916810 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAYLOR INTERNAL MEDICINE OF SELMA EMPLOYEES SAVINGS TRUST | 2016 | 412097255 | 2017-10-17 | TAYLOR INTERNAL MEDICINE OF SELMA | 25 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-10-17 |
| Name of individual signing | BRUCE E. TAYLOR, MD |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748800 |
| Plan sponsor’s address | 4258 HWY 80 W., SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2016-11-01 |
| Name of individual signing | BRUCE E. TAYLOR, MD |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748800 |
| Plan sponsor’s address | 4258 HWY 80 W., SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2015-10-15 |
| Name of individual signing | BRUCE E. TAYLOR, MD |
| File | View Page |
| Three-digit plan number (PN) | 003 |
| Effective date of plan | 2012-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748800 |
| Plan sponsor’s address | 4258 HWY 80 W., SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2014-10-15 |
| Name of individual signing | BRUCE E. TAYLOR, MD |
| Name | Role |
|---|---|
| TAYLOR, BRUCE EDWARD | Agent |
| Name | Role | Address |
|---|---|---|
| BRYANT, WILLIAM J | Incorporator | 2000 SOUTHBRIDGE PARKWAY STE 500BIRMINGHAM, AL 35209 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
