| Name: | Moundville Medical Plaza, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 06 Apr 1992 (33 years ago) (Companies founded in April 1992) |
| Entity Number: | 000-148-970 |
| Register Number: | 000148970 |
| ZIP code: | 35474 (Companies in Hale, 35474) |
| County: | Hale |
| Place of Formation: | Tuscaloosa County |
| Registered Office Mailing Address: | P.O. BOX 551MOUNDVILLE, AL 35474-0551 |
| Registered Office Street Address: | 16061 HWY 69 SOUTHMOUNDVILLE, AL 35474 |
| Authorized Capital: | $100 |
| Paid Share Capital: | $100 |
Activities
DRUGS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013032648 | 2007-03-20 | 2008-06-16 | 16061 HWY 69 SOUTH, P.O. BOX 551, MOUNDVILLE, AL, 35474, US | 16061 HWY 69 SOUTH, MOUNDVILLE, AL, 35474, US | |||||||||||||||||||||
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| Phone | +1 205-371-9031 |
| Fax | 2053719074 |
Authorized person
| Name | MR. CLIFFORD ALLEN HARLAND JR. |
| Role | PRESIDENT |
| Phone | 2053719031 |
Taxonomy
| Taxonomy Code | 183500000X - Pharmacist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100001507 |
| State | AL |
| Name | Role |
|---|---|
| HARLAND, ALLEN | Agent |
| Name | Role |
|---|---|
| HARLAND, ALLEN | Director |
| Name | Role |
|---|---|
| HARLAND, ALLEN | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
