| Name: | Summerdale Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 29 Mar 2005 (20 years ago) (Companies founded in March 2005) |
| Entity Number: | 000-240-789 |
| Register Number: | 000240789 |
| ZIP code: | 36580 (Companies in Baldwin, 36580) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | SUMMERDALE, AL |
| Registered Office Street Address: | 902 HWY 59 SOUTHSUMMERDALE, AL 36580 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
CARRY ON ALL BRANCHES OF THE MEDICAL PROFESSION
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508043662 | 2008-01-30 | 2013-12-18 | PO BOX 600, SUMMERDALE, AL, 365800600, US | 109 HIGHWAY 59 N, SUMMERDALE, AL, 36580, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 251-989-9400 |
| Fax | 2519892090 |
Authorized person
| Name | DR. MICHAEL TODD SANFORD |
| Role | PRESIDENT |
| Phone | 2519899400 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 26509 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051555997 |
| State | AL |
| Name | Role |
|---|---|
| SANFORD, TODD | Agent |
| Name | Role |
|---|---|
| SANFORD, TODD | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
