| Name: | Mitchum Medical Clinic, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 06 Jun 2005 (19 years ago) (Companies founded in June 2005) |
| Date of dissolution: | 18 Nov 2009 |
| Entity Number: | 000-241-805 |
| Register Number: | 000241805 |
| ZIP code: | 36340 (Companies in Geneva, 36340) |
| County: | Geneva |
| Place of Formation: | Geneva County |
| Principal Address: | GENEVA, AL |
| Registered Office Street Address: | 100 WEST LAKE PROFESSIONAL PARKGENEVA, AL 36340 |
| Authorized Capital: | $5,000 |
| Paid Share Capital: | $1,000 |
Activities
GENERAL FAMILY MEDICAL CLINIC
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578676078 | 2006-08-17 | 2007-09-20 | 100 W LAKE PROFESSIONAL PARK, GENEVA, AL, 363401203, US | 100 W LAKE PROFESSIONAL PARK, GENEVA, AL, 363401203, US | |||||||||||||||||||
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| Phone | +1 334-684-9400 |
| Fax | 3346846262 |
Authorized person
| Name | DR. OTIS DALE MITCHUM |
| Role | PRESIDENT/PHYSICIAN |
| Phone | 3346849400 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 2656 |
| State | AL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MITCHUM MEDICAL CLINIC, INC. RETIREMENT PLAN | 2009 | 202886961 | 2010-10-14 | MITCHUM MEDICAL CLINIC, INC. | 6 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 202886961 |
| Plan administrator’s name | MITCHUM MEDICAL CLINIC, INC. |
| Plan administrator’s address | 100 WEST LAKE PROFESSIONAL PARK, GENEVA, AL, 36340 |
| Administrator’s telephone number | 3346849400 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-14 |
| Name of individual signing | O.D. MITCHUM |
| Role | Employer/plan sponsor |
| Date | 2010-10-14 |
| Name of individual signing | O.D. MITCHUM |
| Name | Role |
|---|---|
| MITCHUM, O D | Incorporator |
| Name | Role |
|---|---|
| MITCHUM, O D | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
