| Name: | Cullman County Medical Clinic, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Merged |
| Date of registration: | 17 Feb 1995 (30 years ago) (Companies founded in February 1995) |
| Entity Number: | 000-170-000 |
| Register Number: | 000170000 |
| Historical Names: |
Woodland Medical Clinic, Inc.
|
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Cullman County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | ---- |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609879220 | 2005-05-27 | 2008-08-04 | 1910 CHEROKEE AVE. SW, CULLMAN, AL, 35055, US | 1910 CHEROKEE AVE SW, CULLMAN, AL, 350555502, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 256-739-3500 |
| Fax | 2567756119 |
| Fax | 2567361093 |
Authorized person
| Name | MRS. SHANA JOCHUM HICE |
| Role | DIRECTOR, PHYSICIAN PRACTICES |
| Phone | 2567365328 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2084A0401X - Addiction Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529907580 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role |
|---|---|
| PAYTON, ROBIN J | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1995-03-07 | Name Change | Woodland Medical Clinic, Inc. | Cullman County Medical Clinic, Inc. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
