| Name: | East Bay Medical, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 04 Apr 2006 (19 years ago) |
| Date of dissolution: | 17 Oct 2012 |
| Entity Number: | 000-246-657 |
| Register Number: | 000246657 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | FAIRHOPE, AL |
| Registered Office Street Address: | 16989 FERRY RDFAIRHOPE, AL 36532 |
| Registered Office Street Address ZIP Code: | 36532 |
| Authorized Capital: | $5,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942223201 | 2006-07-26 | 2008-04-14 | 105B LOTTIE LANE, FAIRHOPE, AL, 36532, US | 105B LOTTIE LANE, FAIRHOPE, AL, 36532, US | |||||||||||||||||||||||||
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| Phone | +1 251-990-7330 |
| Fax | 2519907331 |
Authorized person
| Name | DR. FRANCISCO J. QUINONES |
| Role | PRESIDENT |
| Phone | 2519907330 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RP1001X - Pulmonary Disease Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529930530 |
| State | AL |
| Name | Role |
|---|---|
| QUINONES, FRANCISCO J | Agent |
| Name | Role | Address |
|---|---|---|
| CROWLEY, JOHN J JR | Incorporator | 2610-B DAUPHIN STREET SUITE 101MOBILE, AL 36606 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
