| Name: | Healogics Specialty Physicians of Alabama, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Jul 2014 (10 years ago) (Companies founded in July 2014) |
| Entity Number: | 000-314-832 |
| Register Number: | 000314832 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | 5220 BELFORT ROAD SUITE 130JACKSONVILLE, FL 32256 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
Activities
HEALTHCARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992189443 | 2015-07-15 | 2023-06-01 | 5220 BELFORT RD STE 130, JACKSONVILLE, FL, 322566018, US | 55 ALISON DR, ALEXANDER CITY, AL, 350104409, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 904-446-3451 |
| Fax | 9044463032 |
| Phone | +1 256-215-7450 |
| Fax | 2562157451 |
Authorized person
| Name | FRANK WILLIAMS |
| Role | CEO |
| Phone | 9044463519 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | No |
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | No |
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| Is Primary | No |
| Taxonomy Code | 2083P0011X - Undersea and Hyperbaric Medicine (Preventive Medicine) Physician |
| Is Primary | Yes |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 179100 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
| Name | Role | Address |
|---|---|---|
| HUGHES, CULLIN | Organizer | 900 W 48TH PLACE SUITE 900KANSAS CITY, MO 64112 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
