| Name: | Stidham Medical, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 05 Aug 2014 (10 years ago) |
| Entity Number: | 000-315-331 |
| Register Number: | 000315331 |
| County: | Cullman |
| Place of Formation: | Cullman County |
| Registered Office Street Address: | 2457 COUNTY ROAD 1352VINEMONT, AL 35179 |
| Registered Office Street Address ZIP Code: | 35179 |
Activities
MOBILE MEDICAL IMAGING SERVICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679528186 | 2006-05-23 | 2015-03-27 | 1890 AL HIGHWAY 157 STE 220, CULLMAN, AL, 350580689, US | 1890 AL HIGHWAY 157 STE 220, CULLMAN, AL, 350580689, US | |||||||||||||||||||||||
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| Phone | +1 256-739-1233 |
| Fax | 2567345129 |
Authorized person
| Name | DR. JEREMY STIDHAM |
| Role | PRESIDENT/OWNER |
| Phone | 2567391233 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000032914 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STIDHAM MEDICAL, LLC 401(K) PLAN | 2017 | 471558603 | 2018-07-30 | STIDHAM MEDICAL, LLC | 11 | |||||||||||||
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| STIDHAM MEDICAL, LLC 401(K) PLAN | 2017 | 471558603 | 2018-09-19 | STIDHAM MEDICAL, LLC | 10 | |||||||||||||
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| STIDHAM MEDICAL, LLC 401(K) PLAN | 2016 | 471558603 | 2017-07-27 | STIDHAM MEDICAL, LLC | 11 | |||||||||||||
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| STIDHAM MEDICAL, LLC 401(K) PLAN | 2015 | 471558603 | 2016-10-12 | STIDHAM MEDICAL, LLC | 0 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| STIDHAM, JEROME V | Agent | 2457 COUNTY ROAD 1352VINEMONT, AL 35179 |
| Name | Role | Address |
|---|---|---|
| STIDHAM, JEROME V | Member | 2457 COUNTY ROAD 1352VINEMONT, AL 35179 |
| Name | Role | Address |
|---|---|---|
| STIDHAM, JEREMY V | Organizer | 2137 COUNTY ROAD 1605CULLMAN, AL 35058 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
