| Name: | Tri-City Neurology, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 02 Feb 2009 (16 years ago) |
| Entity Number: | 000-429-873 |
| Register Number: | 000429873 |
| County: | Talladega |
| Place of Formation: | Talladega County |
| Principal Address: | PELL CITY, AL |
| Registered Office Street Address: | 200 BATTLE STREET EASTTALLADEGA, AL 35160 |
| Registered Office Street Address ZIP Code: | 35160 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437384732 | 2009-05-16 | 2009-05-16 | 200 BATTLE ST E, TALLADEGA, AL, 351602420, US | 200 BATTLE ST E, TALLADEGA, AL, 351602420, US | |||||||||||||||||||||||
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| Phone | +1 256-493-0349 |
Authorized person
| Name | DR. FAZAL RAHIM |
| Role | OWNER |
| Phone | 2564930349 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | 25571 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009960855 |
| State | AL |
| Name | Role |
|---|---|
| RAHIM, FAZAL | Agent |
| Name | Role |
|---|---|
| RAHIM, FAZAL | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
