| Name: | Hendricks Family Practice, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 25 Jul 2006 (18 years ago) |
| Entity Number: | 000-248-364 |
| Register Number: | 000248364 |
| County: | Morgan |
| Place of Formation: | Madison County |
| Principal Address: | DECATUR, AL |
| Registered Office Street Address: | 2699 SANDLIN RD SW STE B8DECATUR, AL 35601 |
| Registered Office Street Address ZIP Code: | 35601 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $100 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568419810 | 2006-05-30 | 2020-07-29 | 2699 SANDLIN RD SW, SUITE B-8, DECATUR, AL, 356017343, US | 2699 SANDLIN RD SW, SUITE B-8, DECATUR, AL, 356017343, US | |||||||||||||||||||||||||
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| Phone | +1 256-301-0560 |
| Fax | 2563010563 |
Authorized person
| Name | DR. MALCOLM R HENDRICKS |
| Role | CO-OWNER/PHYSICIAN |
| Phone | 2563010560 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 26531 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102364 |
| State | AL |
| Name | Role |
|---|---|
| HENDRICKS, MALCOLM | Agent |
| Name | Role | Address |
|---|---|---|
| HENDRICKS, MALCOLM | Incorporator | No data |
| HENDRICKS, TIFFANY | Incorporator | 141 MISTY RIVER LANEHUNTSVILLE, AL 35824 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
