Mitchum Medical Clinic, Inc.

Details

Name:	Mitchum Medical Clinic, Inc.
Jurisdiction:	Alabama
Legal type:	Domestic Corporation
Status:	Dissolved
Date of registration:	06 Jun 2005 (19 years ago)
Date of dissolution:	18 Nov 2009
Entity Number:	000-241-805
Register Number:	000241805
County:	Geneva
Place of Formation:	Geneva County
Principal Address:	GENEVA, AL
Registered Office Street Address:	100 WEST LAKE PROFESSIONAL PARKGENEVA, AL 36340
Registered Office Street Address ZIP Code:	36340
Authorized Capital:	$5,000
Paid Share Capital:	$1,000

Activities GENERAL FAMILY MEDICAL CLINIC

National Provider Identifier

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

Contacts

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

form 5500

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.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-01-01
Business code	541990
Sponsor’s telephone number	3346849400
Plan sponsor’s address	100 WEST LAKE PROFESSIONAL PARK, GENEVA, AL, 36340

Plan administrator’s name and address

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

Incorporator

Name	Role
MITCHUM, O D	Incorporator

Agent

Name	Role
MITCHUM, O D	Agent

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State