| Name: | 604 Medical Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 27 Jun 1995 (29 years ago) |
| Date of dissolution: | 30 Dec 2019 |
| Entity Number: | 000-173-012 |
| Register Number: | 000173012 |
| County: | Monroe |
| Place of Formation: | Monroe County |
| Registered Office Street Address: | 604 MEDICA CENTERMONROEVILLE, AL 36460 |
| Registered Office Street Address ZIP Code: | 36460 |
| Authorized Capital: | $3,000 |
| Paid Share Capital: | ---- |
Activities
GENERALLY DEAL IN REAL ESTATE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235175266 | 2006-06-20 | 2008-07-01 | 16 MEDICAL CENTER DRIVE, MONROEVILLE, AL, 36460, US | 16 MEDICAL CENTER DRIVE, MONROEVILLE, AL, 36460, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 251-575-3266 |
| Fax | 2515753262 |
Authorized person
| Name | DEBBIE WATERS |
| Role | OFFICE MANAGER |
| Phone | 2515753266 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529911320 |
| State | AL |
| Name | Role |
|---|---|
| SMITH, S B DR | Incorporator |
| SIMMONS, A G DR | Incorporator |
| MARTENS, C W DR | Incorporator |
| Name | Role |
|---|---|
| SMITH, S B OR SIMMONS, A G | Agent |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
