| Name: | Decatur Internal Medicine Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 01 Oct 1997 (27 years ago) |
| Entity Number: | 000-190-575 |
| Register Number: | 000190575 |
| County: | Morgan |
| Place of Formation: | Morgan County |
| Principal Address: | DANVILLE, AL |
| Registered Office Street Address: | 2424 DANVILLE ROADDECATUR, AL 35601 |
| Registered Office Street Address ZIP Code: | 35601 |
| Authorized Capital: | $10,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL SERVICES TO THE PUBLIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043246432 | 2006-06-25 | 2007-12-20 | PO BOX 870, CULLMAN, AL, 350560870, US | 2506 DANVILLE RD SW, SUITE 101, DECATUR, AL, 356034232, US | |||||||||||||||||||||||
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| Phone | +1 256-775-0432 |
| Phone | +1 256-350-6363 |
| Fax | 2563506855 |
Authorized person
| Name | DR. KIRK LEE JACKSON |
| Role | PRESIDENT |
| Phone | 2563506363 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DG3025 |
| State | AL |
| Name | Role |
|---|---|
| JACKSON, KIRK L | Agent |
| Name | Role |
|---|---|
| JACKSON, KIRK L | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
