| Name: | Jacksonville Internal Medicine, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 12 Aug 2003 (21 years ago) |
| Entity Number: | 000-230-499 |
| Register Number: | 000230499 |
| County: | Calhoun |
| Place of Formation: | Jefferson County |
| Principal Address: | JACKSONVILLE, AL |
| Registered Office Street Address: | 2270 PELHAM ROAD SOUTHJACKSONVILLE, AL 36265 |
| Registered Office Street Address ZIP Code: | 36265 |
| Authorized Capital: | $1,000 |
Activities
MEDICINE PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811066103 | 2006-11-08 | 2012-01-11 | PO BOX 550, JACKSONVILLE, AL, 36265, US | 2270 PELHAM RD S, JACKSONVILLE, AL, 362659582, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-435-5499 |
| Fax | 2564356064 |
Authorized person
| Name | DR. REY GAVINO |
| Role | OWNER |
| Phone | 2564355499 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 25404 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CLIA |
| Number | 01D1017203 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529917260 |
| State | AL |
| Name | Role |
|---|---|
| GAVINO, REY SAC | Agent |
| Name | Role |
|---|---|
| GAVINO, REY SACAY | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2006-08-21 | Name Merged | No data | Joy Gavino, M.D., P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
