| Name: | West Alabama Orthopaedic and Sports Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Apr 2005 (20 years ago) |
| Entity Number: | 000-240-870 |
| Register Number: | 000240870 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | NORTHPORT, AL |
| Registered Office Street Address: | 1325 MCFARLAND BLVDNORTHPORT, AL 35476 |
| Registered Office Street Address ZIP Code: | 35476 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760420384 | 2006-06-04 | 2009-02-04 | PO BOX 840, NORTHPORT, AL, 354760840, US | 1325 MCFARLAND BLVD, SUITE 102, NORTHPORT, AL, 354763270, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-333-8800 |
| Fax | 2053338406 |
Authorized person
| Name | MRS. KATHRYN BANKS PRITCHETT |
| Role | INSURANCE SPECIALIST |
| Phone | 2053304206 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | 00009008 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | 00022472 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | DO932 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529923320 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| STEWART, WILLIAM B | Incorporator | 800 SHADES CREEK PARKWAY, SUITE 400BIRMINGHAM, AL 35209-1196 |
| Name | Role |
|---|---|
| BARRINEAU, BONY F | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
