| Name: | Fairhope Family Medicine, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 16 Oct 2006 (18 years ago) |
| Entity Number: | 000-485-291 |
| Register Number: | 000485291 |
| County: | Baldwin |
| Place of Formation: | Montgomery County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | 21875 STATE HWY 181FAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821151093 | 2006-12-19 | 2012-09-12 | 21875 STATE HIGHWAY 181, FAIRHOPE, AL, 365321265, US | 21875 STATE HIGHWAY 181, FAIRHOPE, AL, 36532, US | |||||||||||||||||||||
|
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| Phone | +1 251-928-1442 |
Authorized person
| Name | REGAN MARY ANDRADE |
| Role | OWNER |
| Phone | 2519281442 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | MD27544 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI NUMBER |
| Number | 1851370266 |
| Name | Role |
|---|---|
| ANDRADE, REGAN M | Member |
| Name | Role |
|---|---|
| ANDRADE, REGAN M | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
