| Name: | Cary Creek Medical, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 05 Nov 2008 (16 years ago) |
| Entity Number: | 000-259-123 |
| Register Number: | 000259123 |
| Historical Names: |
EXECUTIVE PARK FAMILY MEDICINE, P.C.
|
| County: | Lee |
| Place of Formation: | Lee County |
| Registered Office Street Address: | 2123 EXECUTIVE PARK DROPELIKA, AL 36801 |
| Registered Office Street Address ZIP Code: | 36801 |
| Authorized Capital: | $10,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265687818 | 2008-11-24 | 2023-11-15 | 7667 ALABAMA HWY 51 SUITE B, OPELIKA, AL, 36804, US | 7667 ALABAMA HWY 51 SUITE B, OPELIKA, AL, 36804, US | |||||||||||||||||||||||||
|
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| Phone | +1 334-737-5557 |
| Fax | 3347675646 |
Authorized person
| Name | DR. MARTIN ROACH |
| Role | OWNER/MD |
| Phone | 3347375557 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | DO866 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51595037 |
| State | AL |
| Name | Role |
|---|---|
| ROACH, MARTIN G | Agent |
| Name | Role |
|---|---|
| ROACH, MARTIN G | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2012-03-28 | Name Change | EXECUTIVE PARK FAMILY MEDICINE, P.C. | Cary Creek Medical, P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
