| Name: | Parkway Family Practice, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 20 Feb 2002 (23 years ago) |
| Date of dissolution: | 25 Aug 2022 |
| Entity Number: | 000-680-435 |
| Register Number: | 000680435 |
| County: | Saint Clair |
| Place of Formation: | Saint Clair County |
| Principal Address: | MOODY, AL |
| Registered Office Street Address: | 2834 MOODY PARKWAYMOODY, AL 35004 |
| Registered Office Street Address ZIP Code: | 35004 |
Activities
PROVIDE HEALTH SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063601094 | 2007-10-16 | 2008-05-13 | 2834 MOODY PKWY, MOODY, AL, 350043101, US | 2834 MOODY PKWY, MOODY, AL, 350043101, US | |||||||||||||||||||||
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| Phone | +1 205-640-2808 |
| Fax | 2056402810 |
Authorized person
| Name | DR. JOHN RAINES |
| Role | PHYSICIAN |
| Phone | 2056402808 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529912430 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PERKINS, THOMAS R JR | Agent | 7891 WYNWOOD ROADTRUSSVILLE, AL 35173 |
| Name | Role | Address |
|---|---|---|
| PERKINS, THOMAS R JR | Member | 7891 WYNWOOD ROADTRUSSVILLE, AL 35173 |
| PERKINS, MICHELE D | Member | 7891 WYNWOOD ROADTRUSSVILLE, AL 35173 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
