| Name: | The Practice-Monroeville, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 27 Sep 2006 (18 years ago) |
| Entity Number: | 000-249-362 |
| Register Number: | 000249362 |
| County: | Monroe |
| Place of Formation: | Monroe County |
| Principal Address: | MONROEVILLE, AL |
| Registered Office Street Address: | 1075 DREWRY RD STE BMONROEVILLE, AL 36460 |
| Registered Office Street Address ZIP Code: | 36460 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
OPERATE/MANAGE HEALTH CARE FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972606531 | 2006-09-07 | 2022-11-16 | 1075 DREWRY RD, SUITE B, MONROEVILLE, AL, 36460, US | 1075 DREWRY RD, SUITE B, MONROEVILLE, AL, 36460, US | |||||||||||||||||||||
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| Phone | +1 251-575-5988 |
| Fax | 2515755970 |
Authorized person
| Name | JACKIE WRIGHT |
| Role | OFFICE MANAGER |
| Phone | 2515755988 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529911320 |
| State | AL |
| Name | Role |
|---|---|
| POWELL, ANGELA A | Agent |
| Name | Role |
|---|---|
| POWELL, ANGELA A | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
