| Name: | Madison Valley Pediatrics, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 19 Apr 2005 (20 years ago) |
| Entity Number: | 000-240-983 |
| Register Number: | 000240983 |
| Historical Names: |
Madison Valley Pediatrics, P.C.
Madison Valley Pediatrics, Inc. |
| County: | Madison |
| Place of Formation: | Morgan County |
| Registered Office Street Address: | 101 WESTOVER CIRCLE STE AMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
| Principal Address: | 101 WESTOVER CIRCLE SUITE AMADISON, AL 35758 |
| Principal Address ZIP Code: | 35758 |
| Authorized Capital: | $500 |
Activities
PROVIDE MEDICAL SERVICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053405316 | 2006-10-03 | 2020-08-22 | 3809 SULLIVAN ST, STE 5, MADISON, AL, 35758, US | 3809 SULLIVAN ST, STE 5, MADISON, AL, 35758, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-461-0209 |
| Fax | 2567721506 |
Authorized person
| Name | MRS. BEVERLY D YOUNG |
| Role | OFFICE MANAGER |
| Phone | 2564610209 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| License Number | 20565 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DRJACQUELINE C GALES NPI |
| Number | 1659348019 |
| Issuer | BLUE CROSS |
| Number | 51000822 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CRESPO-GALES, JACQUELINE | Agent | 101 WESTOVER CIRCLE SUITE AMADISON, AL 35758 |
| Name | Role | Address |
|---|---|---|
| CRESPO-GALES, JACQUELINE | Director | 101 WESTOVER CIRCLE SUITE AMADISON, AL 35758 |
| HEMBREE, LONNA | Director | 101 WESTOVER CIRCLE SUITE AMADISON, AL 35758 |
| Name | Role | Address |
|---|---|---|
| CRESPO-GALES, JACQUELINE | Incorporator | 101 WESTOVER CIRCLE SUITE AMADISON, AL 35758 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2018-11-05 | Name Change | Madison Valley Pediatrics, Inc. | Madison Valley Pediatrics, P.C. |
| 2014-12-31 | Name Change | Madison Valley Pediatrics, P.C. | Madison Valley Pediatrics, Inc. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
