| Name: | Nephrology of North Alabama, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 18 May 1993 (32 years ago) |
| Entity Number: | 000-158-100 |
| Register Number: | 000158100 |
| ZIP code: | 35801 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 200 WEST COURT SQUARE STE 810HUNTSVILLE, AL 35801 |
| Authorized Capital: | $500 |
| Paid Share Capital: | ---- |
Activities
PRACTICE OF MEDICINE
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEJWG9JMKZ45 | 2024-09-20 | 1216 SOMERVILLE RD SE, DECATUR, AL, 35601, 4335, USA | 1216 SOMERVILLE RD SE, DECATUR, AL, 35601, 4335, USA | |||||||||||||||||||||||||||||||||||||||||||
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| Division Name | NEPHROLOGY OF NORTH ALABAMA PC |
| Congressional District | 05 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2023-09-25 |
| Initial Registration Date | 2020-11-24 |
| Entity Start Date | 1993-05-18 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 621111 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CHRISTI RUTHERFORD |
| Role | BILLING |
| Address | 1216 SOMERVILLE RD SE, DECATUR, AL, 35601, 4335, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CHRISTI RUTHERFORD |
| Role | BILLING |
| Address | 1216 SOMERVILLE RD SE, DECATUR, AL, 35601, 4335, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417981622 | 2006-07-11 | 2023-05-16 | 1216 SOMERVILLE RD SE, DECATUR, AL, 356014335, US | 1216 SOMERVILLE ROAD SE, DECATUR, AL, 356013337, US | |||||||||||||||||||||
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| Phone | +1 256-340-0012 |
| Fax | 2563401408 |
Authorized person
| Name | DR. REGINALD DWAIN GLADISH |
| Role | OWNER |
| Phone | 2563400012 |
Taxonomy
| Taxonomy Code | 207RN0300X - Nephrology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | CK3006 |
| State | AL |
| Name | Role |
|---|---|
| GWYN, S REVELLE | Agent |
| Name | Role |
|---|---|
| GIFFORD, J DANIEL MD | Incorporator |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6597237003 | 2020-04-07 | 0459 | PPP | 1216 SOMERVILLE ROAD SE, DECATUR, AL, 35601-4335 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
