| Name: | Valley Medical & Surgical Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 24 Oct 1979 (45 years ago) |
| Entity Number: | 000-059-597 |
| Register Number: | 000059597 |
| Historical Names: |
Michael Alan Grossman, M.D., P.C.
Valley Heart & Lung Clinic, P.C. |
| Place of Formation: | Chambers County |
| Principal Address: | LANGDALE, AL |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
INTERNAL MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164621223 | 2007-07-17 | 2009-01-26 | 21 MEDICAL PARK, VALLEY, AL, 368543665, US | 21 MEDICAL PARK, VALLEY, AL, 368543665, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-756-4156 |
| Fax | 3347568181 |
Authorized person
| Name | MITCHEL L GALISHOFF |
| Role | BUSINESS OWNER |
| Phone | 3347564156 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 17338 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529202520 |
| State | AL |
| Issuer | MEDICAID |
| Number | 000594382A |
| State | GA |
| Name | Role |
|---|---|
| GROSSMAN, MICHAEL ALAN | Incorporator |
| GROSSMAN, CECILIA T | Incorporator |
| BONNER, KATHY | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1994-04-11 | Name Change | Valley Heart & Lung Clinic, P.C. | Valley Medical & Surgical Clinic, P.C. |
| 1992-03-02 | Name Change | Michael Alan Grossman, M.D., P.C. | Valley Heart & Lung Clinic, P.C. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
