| Name: | FMC Medical Clinic - Fayette, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Jul 2018 (6 years ago) |
| Entity Number: | 000-524-619 |
| Register Number: | 000524619 |
| County: | Fayette |
| Place of Formation: | Fayette County |
| Registered Office Mailing Address: | 1820 RICE MINE ROAD SUITE 200TUSCALOOSA, AL 35406 |
| Registered Office Mailing Address ZIP Code: | 35406 |
| Registered Office Street Address: | 1653 TEMPLE AVE N SUITE 1FAYETTE, AL 35555 |
| Registered Office Street Address ZIP Code: | 35555 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588141063 | 2018-07-26 | 2018-10-08 | 1820 RICE MINE RD N STE 200, TUSCALOOSA, AL, 354063282, US | 1653 TEMPLE AVE N STE 1, FAYETTE, AL, 355551314, US | |||||||||||||||||
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| Phone | +1 205-333-4661 |
| Fax | 2053334660 |
| Phone | +1 205-932-1112 |
Authorized person
| Name | MR. DANIEL CLAY CONVILLE |
| Role | CORP DIRECTOR PHYSICIAN SERVICES |
| Phone | 2057596165 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JONES, DONALD | Agent | 119 SOUTH ASH AVENUEDEMOPOLIS, AL 36732 |
| Name | Role |
|---|---|
| SNOW, STEPHEN | Organizer |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
