| Name: | Shedden Pain Relief and Sports Medicine, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 12 Sep 2003 (21 years ago) |
| Entity Number: | 000-693-052 |
| Register Number: | 000693052 |
| County: | Houston |
| Place of Formation: | Houston County |
| Registered Office Street Address: | 105 HIDDEN GLEN WAYDOTHAN, AL 36303 |
| Registered Office Street Address ZIP Code: | 36303 |
Activities
PROVIDE OSTEOPATHIC MANIPULATION THERAPY/MASSAGE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801121504 | 2009-10-14 | 2009-10-14 | PO BOX 8365, DOTHAN, AL, 363040365, US | 1733 W MAIN ST, SUITE 100, DOTHAN, AL, 363011330, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-702-9445 |
| Fax | 3347029465 |
Authorized person
| Name | MRS. PATRICIA D. SHEDDEN |
| Role | ADMINISTRATOR |
| Phone | 3347029445 |
Taxonomy
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| License Number | DO118 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | DO118 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 2081S0010X - Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | DO118 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE IDENTIFICATION NUMBER |
| Number | 051554243 |
| State | AL |
| Name | Role |
|---|---|
| SHEDDEN, ROBERT | Agent |
| Name | Role | Address |
|---|---|---|
| SHEDDEN, PATRICIA D | Member | 1730 PEACOCK ROADWEBB, AL 36376 |
| HART, CHRISTOPHER M | Member | No data |
| SHEDDEN, ROBERT D | Member | 1730 PEACOCK ROADWEBB, AL 36376 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
