| Name: | Cullman Dermatology Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 02 Jan 1997 (28 years ago) (Companies founded in January 1997) |
| Date of dissolution: | 29 Dec 2022 |
| Entity Number: | 000-184-283 |
| Register Number: | 000184283 |
| ZIP code: | 35055 (Companies in Cullman, 35055) |
| County: | Cullman |
| Place of Formation: | Cullman County |
| Principal Address: | CULLMAN, AL |
| Registered Office Street Address: | 1205 COUNTY ROAD 1466CULLMAN, AL 35055 |
| Authorized Capital: | $5,000 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003869751 | 2006-05-17 | 2008-05-13 | 1205 COUNTY ROAD 1466, CULLMAN, AL, 350580795, US | 1205 COUNTY ROAD 1466, CULLMAN, AL, 350580795, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-739-9711 |
| Fax | 2567399737 |
Authorized person
| Name | STEVEN M SKINNER |
| Role | PRESIDENT |
| Phone | 2567399711 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | 18046 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | CC9291 |
| Issuer | MEDICAID |
| Number | 529700230 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SKINNER, STEVEN M | Agent | 1470 COUNTY ROAD 558HANCEVILLE, AL 35077 |
| Name | Role | Address |
|---|---|---|
| LEVITT, RONALD A | Incorporator | PO BOX 55727BIRMINGHAM, AL 35255-5727 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
