| Name: | Cullman Heart and Urgent Care, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 12 Jun 1998 (26 years ago) |
| Date of dissolution: | 27 Dec 2023 |
| Entity Number: | 000-196-079 |
| Register Number: | 000196079 |
| Historical Names: |
Cullman Cardiovascular Center, P.C.
|
| County: | Cullman |
| Place of Formation: | Cullman County |
| Registered Office Street Address: | 1722 LOCH DRCULLMAN, AL 35055 |
| Registered Office Street Address ZIP Code: | 35055 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
MEDICAL TREATMENT AND FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134494685 | 2012-03-16 | 2012-03-16 | 1801 PARK VIEW DR, CULLMAN, AL, 350583618, US | 1803 PARK VIEW DR, CULLMAN, AL, 350583618, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-775-6550 |
| Fax | 2567756772 |
| Phone | +1 256-255-1900 |
| Fax | 2562551937 |
Authorized person
| Name | DR. MIR K VARQUEZ |
| Role | PRESIDENT |
| Phone | 2567756550 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | 17814 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | OTHER GROUP NPI |
| Number | 1649334301 |
| Issuer | MEDICAID |
| Number | 529802590 |
| State | AL |
| Name | Role |
|---|---|
| VARQUEZ, MIR KWO | Agent |
| Name | Role |
|---|---|
| VARQUEZ, MIR KWON WU | Incorporator |
| VARQUEZ, GENARO A JR | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2007-11-05 | Name Change | Cullman Cardiovascular Center, P.C. | Cullman Heart and Urgent Care, P.C. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
