| Name: | Innovative Orthopaedics and Sports Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 21 Oct 2004 (20 years ago) |
| Date of dissolution: | 05 Aug 2008 |
| Entity Number: | 000-237-928 |
| Register Number: | 000237928 |
| Place of Formation: | Lauderdale County |
| Principal Address: | FLORENCE, AL |
| Registered Office Street Address: | 10100 HWY 157FLORENCE, AL 35633-4624 |
| Authorized Capital: | 10,000 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023220688 | 2007-05-04 | 2020-08-22 | 2201 CLOYD BLVD, FLORENCE, AL, 356301505, US | 2201 CLOYD BLVD, FLORENCE, AL, 356301505, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-764-7781 |
| Fax | 2567643908 |
Authorized person
| Name | DR. JOHN T MURPHY |
| Role | PRESIDENT |
| Phone | 2567647781 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | 14844 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 05155430 |
| State | AL |
| Issuer | INDIVIDUAL NPI NUMBER |
| Number | 1003909375 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51000113 |
| State | AL |
| Issuer | RAIL ROAD MEDICARE |
| Number | P00192214 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| MURPHY, JOHN T | Agent | 157 CULVER ELLIS BLVDKILLEN, AL 35645 |
| Name | Role |
|---|---|
| MARSTON, J KENNETH JR | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
