| Name: | Agape Medical Clinic, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 21 Nov 2002 (22 years ago) |
| Entity Number: | 000-226-043 |
| Register Number: | 000226043 |
| ZIP code: | 35570 |
| County: | Marion |
| Place of Formation: | Marion County |
| Principal Address: | HAMILTON, AL |
| Registered Office Street Address: | 206 BEXAR AVE EHAMILTON, AL 35570 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
PRIMARY HEALTHCARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174643852 | 2007-03-29 | 2022-11-10 | PO BOX 2282, HAMILTON, AL, 35570, US | 1911 MILITARY ST S, HAMILTON, AL, 35570, US | |||||||||||||||||||||||||
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| Phone | +1 205-952-9603 |
| Fax | 2059529661 |
Authorized person
| Name | DOROTHY E STIDHAM |
| Role | PRESIDENT |
| Phone | 2059529603 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 1061751 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051552982STI |
| State | AL |
| Name | Role |
|---|---|
| STIDHAM, DOROTHY | Agent |
| Name | Role |
|---|---|
| STIDHAM, DOROTHY | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
