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) (Companies founded in October 1995) |
Entity Number: | 000-174-821 |
Register Number: | 000174821 |
ZIP code: | 35565 (Companies in Winston, 35565) |
County: | Winston |
Place of Formation: | Winston County |
Principal Address: | HALEYVILLE, AL |
Registered Office Street Address: | HWY 195 (PO BOX 655)HALEYVILLE, AL 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 | |||||||||||||||||||||||
|
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