| Name: | Jonathan Smith, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 27 Aug 2009 (15 years ago) |
| Entity Number: | 000-261-835 |
| Register Number: | 000261835 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | SPANISH FORT, AL |
| Registered Office Street Address: | 6945 CARSON LANESPANISH FORT, AL 36527 |
| Registered Office Street Address ZIP Code: | 36527 |
| Authorized Capital: | 100 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194956664 | 2009-08-01 | 2010-11-08 | PO BOX 1627, BAY MINETTE, AL, 365071627, US | 2002 HAND AVE, BAY MINETTE, AL, 36507, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-580-4243 |
| Fax | 2515804189 |
Authorized person
| Name | JONATHAN K SMITH |
| Role | PRESIDENT |
| Phone | 2515804243 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| License Number | 22065 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51049680 |
| State | AL |
| Issuer | MEDICAID |
| Number | 113549 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SMITH, JONATHAN | Agent | 883 BROOKLINE RDGARDENDALE, AL 35071-8379 |
| Name | Role | Address |
|---|---|---|
| SMITH, JONATHAN | Incorporator | 883 BROOKLINE RDGARDENDALE, AL 35071-8379 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
