| Name: | Alex City Internal Medicine & Nephrology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 10 Jul 2003 (21 years ago) |
| Entity Number: | 000-229-868 |
| Register Number: | 000229868 |
| County: | Tallapoosa |
| Place of Formation: | Tallapoosa County |
| Registered Office Street Address: | 3369 HWY 280 STE G10ALEXANDER CITY, AL 35010 |
| Registered Office Street Address ZIP Code: | 35010 |
| Authorized Capital: | $2,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427188119 | 2007-03-06 | 2014-05-05 | 3368 HIGHWAY 280, SUITE 220, ALEXANDER CITY, AL, 350103393, US | 3368 HIGHWAY 280, SUITE 220, ALEXANDER CITY, AL, 350103393, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-409-1500 |
| Fax | 2564091144 |
Authorized person
| Name | DIMTCHO V POPOV |
| Role | PHYSICIAN OWNER |
| Phone | 2564091500 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 20515 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009931175 |
| State | AL |
| Issuer | BCBS |
| Number | 51516344 |
| State | AL |
| Name | Role |
|---|---|
| POPOV, DIMTCHO V | Agent |
| Name | Role |
|---|---|
| POPOV, DIMTCHO V | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
