| Name: | Alabama Obstetrics, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 Jul 2001 (24 years ago) |
| Entity Number: | 000-603-411 |
| Register Number: | 000603411 |
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Georgia |
| Principal Address: | 1031 20TH STREETCOLUMBUS, GA 31901 |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
Activities
PROVIDE OBSTETRIC & GYNECOLOGIC MED SERV TO MEDICADE BENEFICIARI
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104951383 | 2007-02-21 | 2008-01-16 | 1610 OPELIKA ROAD, PHENIX CITY, AL, 36867, US | 1610 OPELIKA ROAD, PHENIX CITY, AL, 36867, US | |||||||||||||||||||||
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| Phone | +1 334-448-4444 |
| Fax | 3344488200 |
Authorized person
| Name | DR. THOMAS N. MALONE |
| Role | PARTNER |
| Phone | 3344484444 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD AL |
| Number | 515 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9324857206 | 2020-04-28 | 0459 | PPP | 1610 OPELIKA RD, PHENIX CITY, AL, 36867-3634 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
