| Name: | Springhill Dermatology Clinic, P. C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 19 Feb 1987 (38 years ago) |
| Date of dissolution: | 04 Jan 2021 |
| Entity Number: | 000-115-671 |
| Register Number: | 000115671 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 4300 OLD SHELL RDMOBILE, AL 36608 |
| Registered Office Street Address ZIP Code: | 36608 |
| Authorized Capital: | $10,000 |
Activities
MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144420936 | 2007-07-20 | 2008-07-08 | 4300 OLD SHELL RD STE B, MOBILE, AL, 366082036, US | 4300 OLD SHELL RD STE B, MOBILE, AL, 366082036, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-342-7880 |
| Fax | 2513428369 |
Authorized person
| Name | DR. BELEN FRED BODIE |
| Role | OWNER |
| Phone | 2513427880 |
Taxonomy
| Taxonomy Code | 207NI0002X - Clinical & Laboratory Dermatological Immunology Physician |
| License Number | 6998 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE RAILROAD |
| Number | CG4447 |
| State | AL |
| Issuer | BLUE CROSS AND BLUE SHIELD |
| Number | 51004869 |
| State | AL |
| Name | Role |
|---|---|
| BODIE, B FRED | Agent |
| Name | Role |
|---|---|
| BODIE, B FRED | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
