| Name: | Baldwin OB-GYN, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 23 Feb 2005 (20 years ago) (Companies founded in February 2005) |
| Entity Number: | 000-240-124 |
| Register Number: | 000240124 |
| Historical Names: |
North Baldwin Ob-Gyn, P.C.
|
| ZIP code: | 36507 (Companies in Baldwin, 36507) |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | BAY MINETTE, AL |
| Registered Office Street Address: | 200 WEST 12TH STBAY MINETTE, AL 36507 |
| Authorized Capital: | $100 |
| Paid Share Capital: | $100 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295940674 | 2007-05-11 | 2016-10-04 | 1506 N MCKENZIE STREET, SUITE 104, FOLEY, AL, 365352264, US | 1506 N MCKENZIE STREET, SUITE 104, FOLEY, AL, 365352264, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 251-424-1100 |
| Fax | 2514241110 |
Authorized person
| Name | JUDY DELACY CLOUSETT |
| Role | PRESIDENT |
| Phone | 2514241100 |
Taxonomy
| Taxonomy Code | 207VH0002X - Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician |
| License Number | 17877 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529922890 |
| State | AL |
| Name | Role |
|---|---|
| CORBETT, JUDY DELACEE | Agent |
| Name | Role |
|---|---|
| CORBETT, JUDY DELACEE | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2009-06-23 | Name Change | North Baldwin Ob-Gyn, P.C. | Baldwin OB-GYN, P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
