| Name: | Kenny E. Smith, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 15 Dec 1994 (30 years ago) (Companies founded in December 1994) |
| Entity Number: | 000-168-435 |
| Register Number: | 000168435 |
| ZIP code: | 35901 (Companies in Etowah, 35901) |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Principal Address: | GADSDEN, AL |
| Registered Office Street Address: | 811 CHESTNUT STGADSDEN, AL 35901 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | ---- |
Activities
ENGAGE IN GENERAL PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629176151 | 2006-09-20 | 2020-08-22 | 760 CHESTNUT ST, GADSDEN, AL, 359014147, US | 760 CHESTNUT ST, GADSDEN, AL, 359014147, US | |||||||||||||||||||||||
|
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| Phone | +1 256-543-1100 |
| Fax | 2565431101 |
Authorized person
| Name | DR. KENNY E SMITH |
| Role | PHYSICIAN/OWNER |
| Phone | 2565431100 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51080192 |
| State | AL |
| Name | Role |
|---|---|
| SMITH, KENNY E | Agent |
| Name | Role |
|---|---|
| SMITH, KENNY E | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
