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Physicians Pain Management, Inc

Details

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.

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
COB, HENRY Agent 3283 MALCOLM DRIVEMONTGOMERY, AL 36116

Director

Name Role Address
COB, HENRY Director 3283 MALCOLM DRIVEMONTGOMERY, AL 36116
COBB, CANDICE Director 3283 MALCOLM DRMONTGOMERY, AL 36116

Incorporator

Name Role Address
COB, HENRY Incorporator 3283 MALCOLM DRIVEMONTGOMERY, AL 36116

Date of last update: 03 Aug 2024

Sources: Alabama Secretary of State