| Name: | Boyde J. Harrison, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 02 Oct 1995 (29 years ago) |
| Entity Number: | 000-174-821 |
| Register Number: | 000174821 |
| County: | Winston |
| Place of Formation: | Winston County |
| Principal Address: | HALEYVILLE, AL |
| Registered Office Street Address: | HWY 195 (PO BOX 655)HALEYVILLE, AL 35565 |
| Registered Office Street Address ZIP Code: | 35565 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
Activities
RENDERING PROFESSIONAL MEDICAL CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689336471 | 2021-10-08 | 2021-10-08 | 42024 HWY 195, HALEYVILLE, AL, 35565, US | 904 26TH STREET, HALEYVILLE, AL, 35565, US | |||||||||||||||||||||||
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| Phone | +1 205-485-7108 |
| Fax | 2054857177 |
| Phone | +1 205-486-5234 |
Authorized person
| Name | ASHOKE 'BAPPA' MUKHERJI |
| Role | JAVA MEDICAL GROUP CEO |
| Phone | 6153088800 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 243660 |
| State | AL |
| Name | Role |
|---|---|
| HARRISON, BOYDE J | Agent |
| Name | Role |
|---|---|
| HARRISON, BOYDE J | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
