| Name: | Genta Medical Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 03 Jan 1994 (31 years ago) |
| Entity Number: | 000-161-165 |
| Register Number: | 000161165 |
| County: | Calhoun |
| Place of Formation: | Calhoun County |
| Principal Address: | JACKSONVILLE, AL |
| Registered Office Street Address: | 1460 FIRST AVE SWJACKSONVILLE, AL 36265 |
| Registered Office Street Address ZIP Code: | 36265 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
RENDER THE PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073612339 | 2006-09-22 | 2008-11-19 | 1460 1ST AVE SW, JACKSONVILLE, AL, 362653329, US | 1460 1ST AVE SW, JACKSONVILLE, AL, 362653329, US | |||||||||||||||||||||||||
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| Phone | +1 256-435-2895 |
| Fax | 2564352969 |
Authorized person
| Name | DR. JOHN OSCAR BROWN |
| Role | PRESIDENT |
| Phone | 2564352895 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 15032 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE NUMBER |
| Number | 15032 |
| State | CA |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GENTA MEDICAL CLINIC, P.C. PROFIT SHARING PLAN AND TRUST | 2009 | 631107223 | 2010-07-19 | GENTA MEDICAL CLINIC, P.C. | 2 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 631107223 |
| Plan administrator’s name | GENTA MEDICAL CLINIC, P.C. |
| Plan administrator’s address | 1460-B FIRST AVE S.W., JACKSONVILLE, AL, 36265 |
| Administrator’s telephone number | 8037875639 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-18 |
| Name of individual signing | JOHN OSCAR BROWN |
| Role | Employer/plan sponsor |
| Date | 2010-07-18 |
| Name of individual signing | JOHN OSCAR BROWN |
| Name | Role |
|---|---|
| BROWN, JOHN O DR | Agent |
| Name | Role |
|---|---|
| BROWN, JOHN O DR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
