| Name: | Southern Medical, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Jan 1995 (30 years ago) (Companies founded in January 1995) |
| Date of dissolution: | 23 Dec 2019 |
| Entity Number: | 000-168-988 |
| Register Number: | 000168988 |
| ZIP code: | 35216 (Companies in Jefferson, 35216) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | HOOVER, AL |
| Registered Office Street Address: | 424 LORNA SQUAREHOOVER, AL 35216 |
| Authorized Capital: | $100 |
| Paid Share Capital: | ---- |
Activities
PHARMACEUTICAL HOME INFUSION SALES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770597262 | 2006-07-28 | 2008-06-25 | 2159 ROCKY RIDGE RD, SUITE 123, HOOVER, AL, 35216, US | 2159 ROCKY RIDGE RD, SUITE 123, HOOVER, AL, 35216, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-822-1972 |
| Fax | 2058222821 |
Authorized person
| Name | MR. T. MICHAEL NELSON |
| Role | PRESIDENT |
| Phone | 2058221972 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251F00000X - Home Infusion Agency |
| License Number | 110489 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 110489 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| License Number | 110489 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS DME PROVIDER |
| Number | 51057969 |
| State | AL |
| Issuer | BCBS HOME HEALTH PROVIDER |
| Number | 51527724 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009703250 |
| State | AL |
| Issuer | NCPDP OR NABP NUMBER |
| Number | 0128199 |
| State | AL |
| Issuer | MEDICAID |
| Number | 100002722 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6T0E6 | Active | Non-Manufacturer | 2012-11-05 | 2014-10-23 | No data | No data | |||||||||||||||
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| POC | T MICHEAL NELSON |
| Phone | +1 205-822-1972 |
| Fax | +1 205-822-2821 |
| Address | 2159 ROCKY RIDGE RD STE 123, BIRMINGHAM, JEFFERSON, AL, 35216 5192, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role |
|---|---|
| NELSON, T MICHAEL | Agent |
| Name | Role |
|---|---|
| NELSON, T MICHAEL | Incorporator |
| NELSON, DEBORAH S | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
