| Name: | Larry T. Bolton, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Jun 1982 (42 years ago) |
| Entity Number: | 000-087-328 |
| Register Number: | 000087328 |
| County: | Jackson |
| Place of Formation: | Jackson County |
| Principal Address: | SCOTTSBORO, AL |
| Registered Office Street Address: | 303 PARKS STSCOTTSBORO, AL 35768 |
| Registered Office Street Address ZIP Code: | 35768 |
| Authorized Capital: | $5,000 |
Activities
MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104133495 | 2010-09-08 | 2010-09-08 | 303 PARKS AVE, SCOTTSBORO, AL, 357682411, US | 303 PARKS AVE, SCOTTSBORO, AL, 357682411, US | |||||||||||||||||||||||||
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| Phone | +1 256-574-3623 |
| Fax | 2565746223 |
Authorized person
| Name | DR. LARRY T BOLTON |
| Role | OWNER |
| Phone | 2565743623 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | 5951 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000000569 |
| State | AL |
| Name | Role |
|---|---|
| BOLTON, LARRY T MD | Agent |
| Name | Role |
|---|---|
| BOLTON, LARRY T MD | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
