| Name: | Intrepid Internal Medicine, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 15 Jun 2010 (14 years ago) (Companies founded in June 2010) |
| Entity Number: | 000-264-461 |
| Register Number: | 000264461 |
| ZIP code: | 35650 (Companies in Lawrence, 35650) |
| County: | Lawrence |
| Place of Formation: | Lawrence County |
| Principal Address: | MOULTON, AL |
| Registered Office Street Address: | 40 MEDICAL CIRCLEMOULTON, AL 35650 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548581705 | 2010-06-22 | 2010-06-22 | 40 MEDICAL CIR, MOULTON, AL, 356501256, US | 40 MEDICAL CIR, MOULTON, AL, 356501256, US | |||||||||||||||||||
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| Phone | +1 256-974-0606 |
| Fax | 2569744530 |
Authorized person
| Name | MONICA COPELAND |
| Role | BILLING MGR |
| Phone | 2565321888 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | DO1056 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| HEINRICH, SHANNON | Agent |
| Name | Role |
|---|---|
| HEINRICH, SHANNON | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
