| Name: | Tuscaloosa Newborn Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Jul 1989 (35 years ago) |
| Date of dissolution: | 30 Nov 2021 |
| Entity Number: | 000-131-985 |
| Register Number: | 000131985 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 1705 ST ANDREWS DRIVETUSCALOOSA, AL 35406 |
| Registered Office Street Address ZIP Code: | 35406 |
| Authorized Capital: | $5,000 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336361732 | 2007-05-03 | 2020-08-22 | 1820 RICE MINE RD NORTH, SUITE 200, TUSCALOOSA, AL, 354063282, US | 1820 RICE MINE RD NORTH, SUITE 200, TUSCALOOSA, AL, 354063282, US | |||||||||||||||||||||||||
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| Phone | +1 205-333-4661 |
| Fax | 2053334660 |
Authorized person
| Name | GUILLERMO GODOY |
| Role | PHYSICIAN OWNER |
| Phone | 2053334661 |
Taxonomy
| Taxonomy Code | 2080N0001X - Neonatal-Perinatal Medicine Physician |
| License Number | 11231 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS NUMBER |
| Number | 51080276 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| GODOY, GUILLERMO | Agent | 1364 DOWNING RIDGETUSCALOOSA, AL 35406 |
| Name | Role | Address |
|---|---|---|
| GODOY, GUILLERMO | Incorporator | 1364 DOWNING RIDGETUSCALOOSA, AL 35406 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
