| Name: | Mitchell Internal Medicine Clinic, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 12 Oct 2006 (18 years ago) |
| Entity Number: | 000-249-509 |
| Register Number: | 000249509 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Principal Address: | FLORENCE, AL |
| Registered Office Street Address: | 2115 CLOYD BLVDFLORENCE, AL 35630 |
| Registered Office Street Address ZIP Code: | 35630 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891866760 | 2006-11-13 | 2020-08-22 | 2115 CLOYD BLVD, SUITE 1, FLORENCE, AL, 356307512, US | 2115 CLOYD BLVD, SUITE 1, FLORENCE, AL, 356307512, US | |||||||||||||||||||||||||
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| Phone | +1 256-718-6858 |
| Fax | 2567186058 |
Authorized person
| Name | IRA LYMAN MITCHELL JR. |
| Role | OWNER |
| Phone | 2567186858 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 00009988 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 51040653 |
| State | AL |
| Name | Role |
|---|---|
| MITCHELL, I LYMAN JR | Agent |
| Name | Role |
|---|---|
| MITCHELL, I LYMAN JR | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
