| Name: | Selma Doctors Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 26 Dec 1991 (33 years ago) |
| Entity Number: | 000-146-883 |
| Register Number: | 000146883 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | SELMA, AL |
| Registered Office Street Address: | 509 PARKMAN AVESELMA, AL 36701 |
| Registered Office Street Address ZIP Code: | 36701 |
| Authorized Capital: | $2,000 |
Activities
MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346625969 | 2015-07-24 | 2015-07-24 | 509 PARKMAN AVE, SELMA, AL, 367015734, US | 509 PARKMAN AVE, SELMA, AL, 367015734, US | |||||||||||||||||||||||||
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| Phone | +1 334-874-9064 |
| Fax | 3348742633 |
Authorized person
| Name | MRS. MARY ELIZABETH SWITZER |
| Role | CRNP |
| Phone | 3348749064 |
Taxonomy
| Taxonomy Code | 364SA2200X - Adult Health Clinical Nurse Specialist |
| License Number | RN1-111824 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000045614 |
| State | AL |
| Name | Role |
|---|---|
| CHITTOM, PARK T MD | Agent |
| Name | Role |
|---|---|
| CHITTOM, PARK T MD | Incorporator |
| ANDERSON, ROBERT E MD | Incorporator |
| CLOWER, DANIEL C III MD | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1991-12-31 | Name Merged | No data | Park T. Chittom, M.D., P.C. |
| 1991-12-31 | Name Merged | No data | Daniel C. Clower, M.D., P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
