| Name: | Coosa Valley Urology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 01 Oct 1980 (44 years ago) (Companies founded in October 1980) |
| Date of dissolution: | 07 Jan 2022 |
| Entity Number: | 000-062-999 |
| Register Number: | 000062999 |
| Place of Formation: | Talladega County |
| Principal Address: | SYLACAUGA, AL |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083831804 | 2007-04-20 | 2013-10-04 | 16 SOUTH DOUGLAS AVENUE, SYLACAUGA, AL, 35150, US | 16 SOUTH DOUGLAS AVENUE, SYLACAUGA, AL, 35150, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-245-2269 |
| Fax | 2562452260 |
Authorized person
| Name | DR. MAMOUN R PACHA |
| Role | OWNER |
| Phone | 2562452269 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 8767 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529603840 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | 340007817 |
| State | AL |
| Issuer | UNITED HEALTH CARE |
| Number | 1910002 |
| State | AL |
| Name | Role |
|---|---|
| PACHA M D, MAMOUN R | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
