| Name: | Trace Crossings Family Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 25 Jan 2001 (24 years ago) |
| Date of dissolution: | 26 May 2009 |
| Entity Number: | 000-214-464 |
| Register Number: | 000214464 |
| ZIP code: | 35244 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | HOOVER, AL |
| Registered Office Street Address: | 118 MARS HILL RDHOOVER, AL 35244 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508942061 | 2006-10-27 | 2020-08-22 | 118 MARS HILL RD, HOOVER, AL, 352443904, US | 118 MARS HILL RD, HOOVER, AL, 352443904, US | |||||||||||||||||||||||||
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| Phone | +1 205-987-0005 |
| Fax | 2059870065 |
Authorized person
| Name | DR. JAMES H MARSHALL |
| Role | PRESIDENT |
| Phone | 2059870005 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | 14054 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS PROVIDER NUMBER |
| Number | 51500656 |
| State | AL |
| Name | Role |
|---|---|
| MARSHALL, JAMES HERBERT | Agent |
| Name | Role |
|---|---|
| MARSHALL, JAMES HERBERT | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
