| Name: | Tennessee Valley Lung Care, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 26 Sep 2005 (19 years ago) |
| Date of dissolution: | 11 Sep 2015 |
| Entity Number: | 000-243-695 |
| Register Number: | 000243695 |
| ZIP code: | 35749 |
| County: | Madison |
| Place of Formation: | Limestone County |
| Registered Office Street Address: | 27669 CAPSHAW ROADHARVEST, AL 35749 |
| Principal Address: | HARVEST, AL |
| Authorized Capital: | $10,000 |
Activities
PULMONARY/INTERNAL MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942359369 | 2007-01-09 | 2009-12-30 | 27669 CAPSHAW RD, SUITE A2, HARVEST, AL, 357497403, US | 27669 CAPSHAW RD., A2, HARVEST, AL, 357497403, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-232-0667 |
| Fax | 2562320557 |
Authorized person
| Name | DR. WILLIAM P THOMAS |
| Role | PRESIDENT |
| Phone | 2562320667 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 16579 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | 16579 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51002887 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009934453 |
| State | AL |
| Issuer | AETNA |
| Number | 5163648 |
| State | AL |
| Name | Role |
|---|---|
| THOMAS, WILLIAM P | Incorporator |
| THOMAS, TONYA L | Incorporator |
| Name | Role |
|---|---|
| THOMAS, WILLIE P | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
