| Name: | Physicians Pain Management, Inc |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 20 Apr 2016 (9 years ago) |
| Date of dissolution: | 08 Jun 2021 |
| Entity Number: | 000-360-792 |
| Register Number: | 000360792 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | 3283 MALCOLM DRIVEMONTGOMERY, AL 36116 |
| Principal Address ZIP Code: | 36116 |
| Authorized Capital: | 100@ $.01PV |
Activities
TO PROVIDE PLAIN MANAGEMENT SERVICES.
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023464856 | 2016-05-11 | 2016-06-27 | PO BOX 660257, BIRMINGHAM, AL, 352660257, US | 3283 MALCOLM DR, SUITE 100, MONTGOMERY, AL, 361168816, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-979-5882 |
| Fax | 2059791248 |
| Phone | +1 334-356-9970 |
| Fax | 3342698783 |
Authorized person
| Name | CANDICE W COBB |
| Role | OWNER |
| Phone | 3343561111 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 186948 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| COB, HENRY | Agent | 3283 MALCOLM DRIVEMONTGOMERY, AL 36116 |
| Name | Role | Address |
|---|---|---|
| COB, HENRY | Director | 3283 MALCOLM DRIVEMONTGOMERY, AL 36116 |
| COBB, CANDICE | Director | 3283 MALCOLM DRMONTGOMERY, AL 36116 |
| Name | Role | Address |
|---|---|---|
| COB, HENRY | Incorporator | 3283 MALCOLM DRIVEMONTGOMERY, AL 36116 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
