| Name: | Gardendale Medical Center, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 10 Sep 1998 (26 years ago) |
| Date of dissolution: | 30 Dec 2008 |
| Entity Number: | 000-197-867 |
| Register Number: | 000197867 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | GARDENDALE, AL |
| Registered Office Street Address: | 2244 N RDGARDENDALE, AL 35071 |
| Registered Office Street Address ZIP Code: | 35071 |
| Authorized Capital: | $1,000 |
Activities
PRACTICE MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548433618 | 2008-04-09 | 2008-04-09 | 2244 NORTH RD, GARDENDALE, AL, 350712206, US | 2244 NORTH RD, GARDENDALE, AL, 350712206, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 205-631-6216 |
Authorized person
| Name | CECILIA G THOMAS |
| Role | INSURANCE CLERK |
| Phone | 2056316216 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTHCARE |
| Number | 0110249 |
| State | AL |
| Issuer | BCBS |
| Number | 51045205 |
| State | AL |
| Issuer | UPIN |
| Number | C72175 |
| State | AL |
| Name | Role |
|---|---|
| DOGANIERO, FRANK J JR | Agent |
| Name | Role |
|---|---|
| DOGANIERO, FRANK J JR | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
