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 | |||||||||||||||||||||||||
|
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