| Name: | Madison Speech Associates, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 15 May 2006 (19 years ago) |
| Date of dissolution: | 02 Jul 2021 |
| Entity Number: | 000-247-379 |
| Register Number: | 000247379 |
| County: | Madison |
| Place of Formation: | Limestone County |
| Principal Address: | MADISON, AL |
| Registered Office Street Address: | 97 HUGHES RD STE LMADISON, AL 35758 |
| Registered Office Street Address ZIP Code: | 35758 |
| Authorized Capital: | 1,000 |
Activities
SPEECH/LANGUAGE THERAPY/DIAGNOSTIC SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942400387 | 2007-07-24 | 2013-01-18 | 103 INTERCOM DR, SUITE C, MADISON, AL, 357582640, US | 103 INTERCOM DR, SUITE C, MADISON, AL, 357582640, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-464-9464 |
| Fax | 2563259469 |
Authorized person
| Name | MRS. SHEILA P. FULLER |
| Role | PRESIDENT |
| Phone | 2564649464 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | 2301 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51536066 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529929330 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7KHZ0 | Obsolete | Non-Manufacturer | 2016-03-03 | 2022-03-02 | 2022-03-01 | No data | |||||||||||||||
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| POC | SHEILA FULLER |
| Phone | +1 256-464-9464 |
| Fax | +1 256-325-9469 |
| Address | 103 INTERCOM DR STE C, MADISON, AL, 35758 2641, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role |
|---|---|
| FULLER, SHEILA P | Incorporator |
| Name | Role |
|---|---|
| FULLER, SHEILA P | Agent |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2007-01-12 | Capital Change | 1 Authorized --- Paid In | 1,000 Authorized undefined Paid In |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
