| Name: | Family Medicine of Russellville,Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 27 Nov 2007 (17 years ago) |
| Date of dissolution: | 27 Dec 2013 |
| Entity Number: | 000-255-207 |
| Register Number: | 000255207 |
| ZIP code: | 35653 |
| County: | Franklin |
| Place of Formation: | Franklin County |
| Principal Address: | RUSSELLVILLE, AL |
| Registered Office Street Address: | 605 GANDY ST NERUSSELLVILLE, AL 35653 |
| Authorized Capital: | $10 |
| Paid Share Capital: | $10 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366625923 | 2007-12-06 | 2008-03-11 | PO BOX 99, RUSSELLVILLE, AL, 356530099, US | 605 GANDY ST NE, RUSSELLVILLE, AL, 356531911, US | |||||||||||||||||||||
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| Phone | +1 256-332-8969 |
| Fax | 2563328353 |
Authorized person
| Name | RYAN ALBERT GREGORIO |
| Role | MD/PRESIDENT |
| Phone | 2563328969 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529933001 |
| State | AL |
| Name | Role |
|---|---|
| GREGORIO, RYAN ALBERT | Agent |
| Name | Role |
|---|---|
| GREGORIO, RYAN ALBERT | Incorporator |
| GAZTAMBIDE, BEATRIZ MARIA RODRIGUEZ | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
