| Name: | Family Medicine of Tuscaloosa, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Oct 2010 (14 years ago) |
| Entity Number: | 000-302-727 |
| Register Number: | 000302727 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 2835 REGATTA WAYTUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104126739 | 2010-10-29 | 2012-03-07 | 100 TOWNCENTER BLVD, SUITE 300, TUSCALOOSA, AL, 354061833, US | 100 TOWNCENTER BLVD, SUITE 300, TUSCALOOSA, AL, 354061833, US | |||||||||||||||||||
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| Phone | +1 205-464-4971 |
| Fax | 2053437425 |
Authorized person
| Name | SHANNON AMMAN |
| Role | MANAGER |
| Phone | 2054644971 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 24343 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHRISTENSEN, EDWIN DALE | Agent | 100 TOWNCENTER BLVD SUITE 300TUSCALOOSA, AL 35406 |
| Name | Role | Address |
|---|---|---|
| CHRISTENSEN, EDWIN DALE | Member | 100 TOWNCENTER BLVD SUITE 300TUSCALOOSA, AL 35406 |
| CHRISTENSEN, NIKKI P | Member | No data |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
