| Name: | Center Star Family Practice, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 21 Oct 2003 (21 years ago) |
| Entity Number: | 000-231-560 |
| Register Number: | 000231560 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Principal Address: | KILLEN, AL |
| Registered Office Street Address: | 6459 HWY 72KILLEN, AL 35645 |
| Registered Office Street Address ZIP Code: | 35645 |
| Authorized Capital: | $1,000 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801950167 | 2006-12-21 | 2011-02-22 | PO BOX 70, KILLEN, AL, 356450070, US | 6459 HIGHWAY 72, KILLEN, AL, 356458258, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 256-272-0275 |
| Fax | 2562720277 |
Authorized person
| Name | DEBRA P. DINGES |
| Role | OWNER |
| Phone | 2562720275 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 1035809 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529919990 |
| State | AL |
| Name | Role |
|---|---|
| DINGES, ROBERT J | Incorporator |
| DINGES, DEBRA P | Incorporator |
| Name | Role |
|---|---|
| DINGES, DEBRA P | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
