| Name: | GULF COAST BEHAVIORAL MEDICINE, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 08 Jun 2012 (12 years ago) |
| Date of dissolution: | 27 Sep 2016 |
| Entity Number: | 000-062-479 |
| Register Number: | 000062479 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 156 E 15TH AVE STE 1GULF SHORES, AL 36542 |
| Registered Office Street Address ZIP Code: | 36542 |
| Authorized Capital: | 1000 @ $1.00 PV |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811251119 | 2012-07-02 | 2012-07-02 | 16478 US HIGHWAY 98, FOLEY, AL, 365358598, US | 16478 US HIGHWAY 98, FOLEY, AL, 365358598, US | |||||||||||||||||||||||||
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| Phone | +1 251-965-2145 |
| Fax | 2519652149 |
Authorized person
| Name | RONNIE ALLEN POLLARD |
| Role | PRESIDENT |
| Phone | 2519652145 |
Taxonomy
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| License Number | AL20541 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 122525 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GULF COAST BEHAVIORAL MEDICINE, PC 401(K) PLAN | 2013 | 455453410 | 2014-10-15 | GULF COAST BEHAVIORAL MEDICINE, PC | 1 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-10-15 |
| Name of individual signing | RONNIE POLLARD |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-06-08 |
| Business code | 621112 |
| Sponsor’s telephone number | 2519652145 |
| Plan sponsor’s address | 16478 U.S. HIGHWAY 98, FOLEY, AL, 36535 |
Signature of
| Role | Plan administrator |
| Date | 2013-09-28 |
| Name of individual signing | RONNIE POLLARD |
| Name | Role |
|---|---|
| POLLARD, RONNIE A | Agent |
| Name | Role |
|---|---|
| POLLARD, RONNIE A | Director |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
