| Name: | FOCUS-MD.com-1006-AL, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Oct 2012 (12 years ago) |
| Entity Number: | 000-269-413 |
| Register Number: | 000269413 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 28080 US HIGHWAY 98 STE FDAPHNE, AL 36526 |
| Registered Office Street Address ZIP Code: | 36526 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962747543 | 2012-12-07 | 2012-12-07 | PO BOX 8159, MOBILE, AL, 366890159, US | 28080 US HIGHWAY 98, SUITE F, DAPHNE, AL, 365267005, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-414-5810 |
| Fax | 2514145809 |
| Phone | +1 251-517-9025 |
| Fax | 2515179026 |
Authorized person
| Name | MICHELLE COLE |
| Role | CREDENTIALING COORDINATOR |
| Phone | 2513002060 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RA0000X - Adolescent Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 2080P0006X - Developmental - Behavioral Pediatrics Physician |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| WILEY, JAMES C | Agent | 3930-F AIRPORT BLVDMOBILE, AL 36608 |
| Name | Role | Address |
|---|---|---|
| WILEY, JAMES C | Organizer | 3930-F AIRPORT BLVDMOBILE, AL 36608 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
