| Name: | Integrated Medical Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 Apr 2020 (5 years ago) |
| Entity Number: | 000-629-735 |
| Register Number: | 000629735 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 975 9TH AVENUE SW SUITE 200BESSEMER, AL 35022 |
| Registered Office Street Address ZIP Code: | 35022 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306469978 | 2020-05-18 | 2020-05-18 | 975 9TH AVE SW STE 200, BESSEMER, AL, 350227839, US | 975 9TH AVE SW STE 200, BESSEMER, AL, 350227839, US | |||||||||||||||||
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| Phone | +1 205-519-4201 |
Authorized person
| Name | LOWELL BRAGG |
| Role | OWNER |
| Phone | 2055194201 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS /BLUE SHIELD OF ALABAMA |
| Number | 512-26348 |
| Name | Role | Address |
|---|---|---|
| BRAGG, LOWELL | Agent | 975 9TH AVENUE SW SUITE 200BESSEMER, AL 35022 |
| Name | Role | Address |
|---|---|---|
| BRAGG, LOWELL | Organizer | 975 9TH AVENUE SW SUITE 200BESSEMER, AL 35022 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
