| Name: | Mobile Obstetrics & Gynecology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Oct 1969 (55 years ago) |
| Entity Number: | 000-012-948 |
| Register Number: | 000012948 |
| Historical Names: |
Mobile Obstetrics & Gynecology, P.A.
|
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 6701 AIRPORT BLVD STE B321MOBILE, AL 36608-6799 |
| Authorized Capital: | $3,000 |
| Paid Share Capital: | $3,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417063637 | 2006-08-21 | 2022-08-15 | 6701 AIRPORT BLVD STE B321, MOBILE, AL, 366086703, US | 6701 AIRPORT BLVD STE B321, MOBILE, AL, 366086703, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 251-633-0793 |
| Fax | 2516330736 |
Authorized person
| Name | MRS. NICOL FORTNER |
| Role | CREDENTIALING |
| Phone | 2516330793 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS-AL NUMBER |
| Number | F789 |
| State | AL |
| Issuer | MEDICAID |
| Number | 528301400 |
| State | AL |
| Issuer | TAXONOMY CODE |
| Number | 207V00000X |
| State | AL |
| Name | Role |
|---|---|
| MADONIA, PHILLIP | Agent |
| Name | Role |
|---|---|
| STEPHENS, SELDEN H JR MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1986-08-21 | Name Change | Mobile Obstetrics & Gynecology, P.A. | Mobile Obstetrics & Gynecology, P.C. |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
