| Name: | Ear, Nose & Throat Clinic, P.A. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Association |
| Status: | Dissolved |
| Date of registration: | 16 Oct 1970 (54 years ago) (Companies founded in October 1970) |
| Date of dissolution: | 01 Feb 2016 |
| Entity Number: | 000-021-231 |
| Register Number: | 000021231 |
| ZIP code: | 35211 (Companies in Jefferson, 35211) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | 652 LOMB AVENUEBIRMINGHAM, AL 35211 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700093986 | 2007-05-17 | 2008-01-23 | 652 LOMB AVE SW, BIRMINGHAM, AL, 352111330, US | 652 LOMB AVE SW, BIRMINGHAM, AL, 352111330, US | |||||||||||||||||||||||||
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| Phone | +1 205-787-1457 |
| Fax | 2057880073 |
Authorized person
| Name | DR. JACK M DABBS |
| Role | PRESIDENT |
| Phone | 2057871457 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | MD2799 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE GROUP # |
| Number | D948 |
| State | AL |
| Name | Role |
|---|---|
| DABBS, JACK M | Member |
| SANDERS, BUFORD B | Member |
| SIMPKINS, THOMAS E JR | Member |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
