| Name: | Gastrointestinal Specialists, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 06 Aug 2002 (22 years ago) |
| Entity Number: | 000-224-420 |
| Register Number: | 000224420 |
| County: | Colbert |
| Place of Formation: | Colbert County |
| Principal Address: | MUSCLE SHOALS, AL |
| Registered Office Street Address: | 104 PHYSICIANS DR #AMUSCLE SHOALS, AL 35661 |
| Registered Office Street Address ZIP Code: | 35661 |
| Authorized Capital: | $1,000 |
Activities
PROVIDE MEDICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003926056 | 2006-08-30 | 2010-02-25 | 104 PHYSICIANS DR, SUITE A, MUSCLE SHOALS, AL, 356612100, US | 104 PHYSICIANS DR, SUITE A, MUSCLE SHOALS, AL, 356612100, US | |||||||||||||||||||||||||
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| Phone | +1 256-314-1010 |
| Fax | 2563140005 |
Authorized person
| Name | MANGESH SHUKLA |
| Role | PRESIDENT |
| Phone | 2563141010 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 18418 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529919500 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GASTROINTESTINAL SPECIALISTS P.C. 401K PLAN | 2017 | 721531035 | 2018-07-15 | GASTROINTESTINAL SPECIALISTS P.C | 12 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2018-07-15 |
| Name of individual signing | MANGESH SHUKLA |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2012-10-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2563141010 |
| Plan sponsor’s address | P O BOX 2890, MUSCLE SHOALS, AL, 35662 |
Signature of
| Role | Plan administrator |
| Date | 2017-10-15 |
| Name of individual signing | MANGESH SHUKLA |
| Name | Role |
|---|---|
| SHUKLA, MANGESH | Agent |
| Name | Role |
|---|---|
| SHUKLA, MANGESH | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
