| Name: | Centre Clinic Corp. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 23 Feb 2006 (19 years ago) (Companies founded in February 2006) |
| Date of dissolution: | 14 Jan 2019 |
| Entity Number: | 000-245-900 |
| Register Number: | 000245900 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2 NORTH JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Authorized Capital: | $10 |
Activities
HEALTH CARE FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558315689 | 2006-05-22 | 2018-04-30 | PO BOX 5009, BRENTWOOD, TN, 370245009, US | 395 NORTHWOOD DR, CENTRE, AL, 359601045, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 615-221-1400 |
| Fax | 6152211484 |
| Phone | +1 256-927-4900 |
| Fax | 2569279151 |
Authorized person
| Name | SOPHIA ARWOOD |
| Role | DIRECTOR; AUTHORIZED OFFICIAL |
| Phone | 6152211400 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208600000X - Surgery Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529928970 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 6190 POWERS FERRY RD STE 600ATLANTA, GA 30339 |
| Name | Role |
|---|---|
| KECK, ROBIN J | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
