| Name: | Coastal States Management, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 26 Sep 1997 (27 years ago) |
| Date of dissolution: | 02 Jan 2007 |
| Entity Number: | 000-190-631 |
| Register Number: | 000190631 |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Principal Address: | GADSDEN, AL |
| Registered Office Street Address: | 177 WILSON DRIVEGADSDEN, AL 35901 |
| Registered Office Street Address ZIP Code: | 35901 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295743078 | 2006-08-04 | 2020-08-22 | 1026 GOODYEAR AVE, BLDG 400, STE 302, GADSDEN, AL, 359031102, US | 1026 GOODYEAR AVE, BLDG 400, STE 302, GADSDEN, AL, 359031102, US | |||||||||||||||||||||||||
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| Phone | +1 256-492-7246 |
| Fax | 2564921186 |
Authorized person
| Name | MRS. MARY KATHERINE JACOBS |
| Role | CHIEF OPERATING OFFICER |
| Phone | 2564927246 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | D0459 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | P00145166 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| MURATTA, PAUL M | Agent | 1026 GOODYEAR AVE BLDG 400 STE 302GADSDEN, AL 35903 |
| Name | Role | Address |
|---|---|---|
| MURATTA, PAUL M | Incorporator | 1026 GOODYEAR AVE BLDG 400 STE 302GADSDEN, AL 35903 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
