| Name: | Coastal Occupational Medicine & Pain Management, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 18 Jun 2004 (20 years ago) |
| Entity Number: | 000-236-096 |
| Register Number: | 000236096 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FOLEY, AL |
| Registered Office Mailing Address: | PO BOX 1862FOLEY, AL 36536 |
| Registered Office Mailing Address ZIP Code: | 36536 |
| Registered Office Street Address: | 915 WEST LAUREL AVENUEFOLEY, AL 36535 |
| Registered Office Street Address ZIP Code: | 36535 |
| Authorized Capital: | 1,000 |
Activities
OCCUPATIONAL MEDICINE/PAIN MANAGEMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699850230 | 2006-10-25 | 2018-02-27 | PO BOX 1862, FOLEY, AL, 365361862, US | 915 W LAUREL AVE, FOLEY, AL, 365351324, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 251-943-5440 |
| Fax | 2519435404 |
Authorized person
| Name | JIMMY STEVEN HANKINS |
| Role | PRESIDENT |
| Phone | 2519435440 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2083P0500X - Preventive Medicine/Occupational Environmental Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2083X0100X - Occupational Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE RAILROAD |
| Number | DE1469 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529921150 |
| State | AL |
| Name | Role |
|---|---|
| HANKINS, J S | Agent |
| Name | Role |
|---|---|
| HANKINS, J STEVEN | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
