| Name: | South Alabama Orthopedics & Sports Medicine. P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 13 Jan 2006 (19 years ago) |
| Date of dissolution: | 30 Jul 2018 |
| Entity Number: | 000-245-112 |
| Register Number: | 000245112 |
| County: | Dale |
| Place of Formation: | Dale County |
| Registered Office Street Address: | 2126 WEST ROY PARKER RD STE 201OZARK, AL 36360 |
| Registered Office Street Address ZIP Code: | 36360 |
| Principal Address: | OZARK, AL |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952311631 | 2006-08-08 | 2014-02-07 | PO BOX 1025, OZARK, AL, 363611025, US | 2126 W ROY PARKER RD, SUITE 201, OZARK, AL, 363608566, US | |||||||||||||||||||||||||
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| Phone | +1 334-445-2663 |
| Fax | 3347747271 |
Authorized person
| Name | DR. DAVID ALAN CLARK |
| Role | PRESIDENT |
| Phone | 3344452663 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| License Number | DO-563 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1952311631 |
| State | AL |
| Name | Role |
|---|---|
| CLARK, DAVID A | Agent |
| Name | Role |
|---|---|
| CLARK, KIMBERLY A | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
