| Name: | Alabama Head & Neck Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 20 Dec 1995 (29 years ago) (Companies founded in December 1995) |
| Date of dissolution: | 09 Jan 2024 |
| Entity Number: | 000-176-506 |
| Register Number: | 000176506 |
| ZIP code: | 35023 (Companies in Jefferson, 35023) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BESSEMER, AL |
| Registered Office Street Address: | 705 MEMORIAL DRIVEBESSEMER, AL 35023 |
| Authorized Capital: | $5,000. |
Activities
PHYSICIAN
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629089701 | 2006-08-11 | 2008-06-09 | PO BOX 1445, BESSEMER, AL, 350211445, US | 730 MEMORIAL DR, SUITE 108, BESSEMER, AL, 350226032, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-424-1450 |
| Fax | 2054246077 |
Authorized person
| Name | DR. JORGE ALBERTO CACERES |
| Role | PRESIDENT / PHYSICIAN |
| Phone | 2054241450 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
| Taxonomy Code | 231H00000X - Audiologist |
| License Number | 572-A |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528200800 |
| State | AL |
| Name | Role |
|---|---|
| CACERES, JORGE A MD | Agent |
| Name | Role |
|---|---|
| CACERES, JORGE A MD | Incorporator |
| ABIDIN, MICHAEL R MD | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
