| Name: | Gadsden Pulmonary and Sleep Clinic, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 30 Aug 1995 (29 years ago) (Companies founded in August 1995) |
| Date of dissolution: | 26 Dec 2019 |
| Entity Number: | 000-174-137 |
| Register Number: | 000174137 |
| Historical Names: |
Luis R Urbina, MD, PC
|
| ZIP code: | 35901 (Companies in Etowah, 35901) |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Principal Address: | GADSDEN, AL |
| Registered Office Street Address: | 601 SOUTH 4TH ST STE BGADSDEN, AL 35901 |
| Authorized Capital: | $2,000 |
| Paid Share Capital: | ---- |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1639391162 | 2007-05-03 | 2015-05-27 | 311 S 4TH ST, GADSDEN, AL, 359015212, US | 311 S 4TH ST, GADSDEN, AL, 359015212, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-547-4443 |
| Fax | 2565474476 |
Authorized person
| Name | MRS. KRISTA J AUTWELL |
| Role | ADM. ASST. |
| Phone | 2565474443 |
Taxonomy
| Taxonomy Code | 207RC0200X - Critical Care Medicine (Internal Medicine) Physician |
| License Number | 00017313 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| License Number | 00017313 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 207RS0012X - Sleep Medicine (Internal Medicine) Physician |
| License Number | 00017313 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | ORGANIZATIONAL (GROUP) NATIONAL PROVIDER IDENTIFIER |
| Number | 1639391162 |
| State | AL |
| Issuer | BCBS PROVIDER NUMBER |
| Number | 510-85402 |
| State | AL |
| Issuer | INDIVIDUAL NPI |
| Number | 1609855063 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009925660 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529904380 |
| State | AL |
| Name | Role |
|---|---|
| URBINA, LUIS R | Incorporator |
| Name | Role |
|---|---|
| URBINA, LUIS R | Agent |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2000-04-05 | Name Change | Luis R Urbina, MD, PC | Gadsden Pulmonary and Sleep Clinic, PC |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
